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Presented  by 
Benjamin  Karz,   D.   0. 


COLLEGE  OF  OSTEOPATHIC  PHYSICIANS 
AND  SURGEONS  •  LOS  ANGELES,  CALIFORNIA 


TH!- 


L-  \^  1  \  /-".  I    L. ! 


Digitized  by  the  Internet  Arciiive 

in  2007  with  funding  from 

IVIicrosoft  Corporation 


http://www.archive.org/details/eclecticpracticeOOscudiala 


THE 


ECLECTIC  PRACTICE 


IN 


DISEASES    OF    CHILDREN. 


n 


BY 


JOHN   >I.  SCUDDER,  M.  D. 


PBOFESSOB  OP  THE   PEISCIPLKS  AND   PKACTICK   OP  MKDICIKK     IN    THE    ECLECTIC    MEDICAL 
IJfSTITUTK     OK    CIKCINNATI  ;     AUTHOR     OP    "  A   TREATISE     ON     THE     DISEASES   OP 
WOMBS,"   "the  ECLECTIC    MATERIA  MKDICA   AND  THERAPEUTICS,"  "  THE 
ECLECTIC  PRACTICR  OP  MEDICINE,"  "  THE    PRIKCIPLK3  OP  MED- 
ICINE,"   "SPECIKIC    MEDICATION,"     "SPECIFIC    DIAQ- 
K08I8,"    "  THE   USB   OP  INHALATIONS,"  ETC. 


REVISED    EDITION. 


CINCINNATI: 
PUBLISHED    BY    THE   AUTHOR* 

1881. 


VWSiOO 

c,  413^  e 

^?1     , 

Entered  according  to  Act  of  Congress,  in  the  years  1869  and  1881, 

BY  JOHN  M.  SCUDDEE, 

In  the  office  of  the  Librarian  of  Congress. 


PREFACE: 


In  presenting  a  new  work  for  approval,  the  author  hopes  that 
it  may  be  as  favorably  received  as  the  former  ones,  and  that  its 
readers  will  find  it  a  trustworthy  guide  in  the  treatment  of  the 
diseases  of  childhood. 

The  dedication  should  have  been  "  to  the  children  of  this 
country,"  as  the  endeavor  has  been  to  free  the  practice  of  medi- 
cine from  everything  harsh  and  revolting,  and  to  substitute  those 
gentle  means  and  appliances  which,  while  successful  in  counter- 
acting disease,  entail  no  present  or  future  suffering. 

The  practice  of  medicine  in  the  past  has  been  a  chapter  of 
horrors,  which  the  truer  civilization  of  the  present  will  not  tol- 
erate, "  We  may  endure  the  sufferings  of  disease,  with  some 
degree  of  equanimity,  but  we  will  not  have  those  sufferings  in- 
tensified by  medicines."  Tliis  is  the  feeling  of  the  better  class 
of  people,  and  especially  of  parents  with  regard  to  their  children. 

If  the  author  has  aided  to  establish  a  better  system  of  med- 
icine, and  the  present  work  fulfills  its  mission  of  rendering  the 
treatment  of  the  diseases  of  childhood  certain  and  pleasant,  he 
will  be  well  repaid  for  his  labor. 

It  has  been  the  object  to  make  the  descriptions  succinct  and 
explicit,  stating  what  the  author  believes  to  be  true,  and  avoid- 
ijig  theories.  Thus,  while  the  entire  list  of  diseases  has  been 
studied,  the  work  has  been  kept  in  that  moderate  compass  that 
renders  it  of  easy  reference  to  the  busy  practitioner. 


viii  •  PREFACE. 

With  regard  to  the  treatment  recommended,  the  author  offers 
the  voucher  of  an  extended  and  successful  practice.  It  varies 
greatly  from  the  treatment  of  the  standard  works  of  the  day, 
or  the  teachings  of  the  schools,  but  upon  it  he  proposes  to  risk 
such  reputation  as  he  may  have  made  as  a  teacher  or  writer. 

But  few  quotations  have  been  made,  and  in  these  cases  due 
credit  has  been  given.  While  acknowledging  no  special  obli- 
gations to  any  writer,  the  author  begs  to  make  that  general 
acknowledgment  to  all  who,  writing  on  medicine,  have  revealed 
the  germs  of  new  truths,  or  have  been  instrumental  in  freeing 
old  ones  from  the  chaff  in  which  they  were  enveloi)ed,  that  they 
might  be  seen  and  applied. 


In  this  revision  the  author  has  added  the  results  of  the  last 
twelve  years'  experience.  The  first  part,  on  infantile  therapcu- 
rapeutics,  has  been  entirely  re- written,  and  forms  a  good  materia 
mediea.  In  the  third  part,  the  treatment  has  been  mostly  re- 
written, and  the  reader  will  find  here  the  most  successful  treat- 
ment of  the  day.  It  is  small  doses  of  pleasant  remedies  for 
direct  effect,  which  we  believe  will  be  the  practice  of  the  future. 
Cincinnati,  June  15tb,  1881. 


TABLE    OF    CONTENTS. 


PART   I. 

INFANTILE  THERAPEUTICS. 

PAGE. 

Chapter  I. — Action  of  Remedies  in  Childhood,        .           .  .17 

Differences  between  the  Adult  and  Child,              .  .           17 

'"           On  account  of  the  Nervous  System,            .  .    17 
"                         "                Circulatory  System  and  Blood,    19 

"                          '*                Digestive  Apparatus,  .            20 

'*                         "                Excretory  Apparatus,  .    20 

Direct  Medication,      ....  .21 

Chapter  II. — Form  in  which  Remedies  should  be  administered,        22 
Solutions  Preferred,  .  ,  .  .  .  .23 

The  Dose  of  Medicine,  .  .  .  .  .  24 

Classification  of  ]\Iedicines,  .  .  .  .  .25 

Remedies  which  Influence  the  Nervous  Sj'stem,    .  .  26 

Gelseminum,        Quinine,  Bromide  of  Ammonium, 

Belladonna,  Opium,  Carbonate  of  Ammonium, 

Rhus.  Phosphorus,     Iodide  of  Ammonium, 

Bryonia,  Camphor,  Ferro  cyanuret  of  Potassium, 

Lobelia,  ^ther,  .^-Enothera, 

Pulsatilla,  Chloroform,      Asafoetida. 

Nux  vomica.        Chloral, 

Remedies  which  Influence  the  Circulation,  .  .  41 

Aconite,  Rhus,  Podophyllin, 

Veratrum.  Lycopus,  Ilamamelis, 

Gelseminum,       Lobelia,  Cactus, 

Eupatorium,       Digitalis,  Apocynum  Canabinum, 

Spiritus  iEtheris  Nitrosi. 


TABLE  OF  CONTEXTS. 

Remedies  which  Influence  the  Temperature, 

Baths,  Veratrum,  Acids, 

Food,  llhus.  Alkalies, 

Air,  Gelseminum,  Cod  Oil, 

Exercise,  Bryonia,  Phosphorus, 

Aconite,  Baptisia,  Sulphur, 

Remedies  which  Influence  the  Respiratory  Apparatus, 


PAGE. 

.    49 


62 


Aconite, 

Veratrum, 

Bryonia, 

Ipecacuanha, 

Lobelia, 

Phytolacca, 


Stillingia, 

Lycopus, 

Drosera, 

Sanguinaria, 

Euphorbia, 

Phosphorus, 


Senega, 

Scilla3, 

Sticta. 

RumeXy. 

Grindelia, 

Nitric  Acid. 


Eupatorium  Perfoliatuni, 
Remedies  which  Influence  the  Digestive  Apparatus, 


69 


Emetics, 

Ipecacuanha, 

Nux  vomica, 

Hydrastis, 

Chamomilla, 

Malt, 

Oxide  of  Zinc, 

Chionanthus, 


Cathartics, 

Coloeynth, 

Chelidonium, 

Dioscorea, 

Iris, 


Amygdalus, 

Hamamelis, 

Podophyllin, 

Apocynum, 

Leptandria, 


Sulphate  of  Manganese,Pepsin, 
Santonine,  Aloes, 

Uvedalia, 

Remedies  which  Influence  the  Urinary  Apparatus,      .  .    82 

Mentha  Viridis,     Sweet  Spirits  of  Nitre,  Rhus  aromatica, 
Gelseminum,  Acetate  of  Potash,        Curcubitacitrullus, 

Eupatorium  pur.   Santonine,  Agrimonia, 

Hydrangea,  Benzoate  of  Lithia,        Belladonna. 

Apis,  Local  Applications  to  the  Loins, 

Remedies  which  Influence  the  Skin,        .  .  .  .87 


Baths, 

Sedatives, 

Rhus, 

Diluents, 

Stimulants, 

Apis, 

Asclepias, 

Inunctions, 

Senega, 

Saff'ron, 

Nepeta, 

Sulphur, 

Belladonna, 

Serpentaria. 

Arsenic. 

Eupatorium. 
Antizymotics, 

.    95 

Acids, 

Sulphurous  Acid, 

Hydrochloric  Acid, 

Baptisia, 

Sulphate  of  Soda, 

Chlorate  of  Potash, 

Phytolacca, 

Antiseptics, 

100 

Thymol, 

Sulphate  of  Iron. 

Chloride  of  Lime, 

Carbolic  Acid, 

Sulphurous  Acid, 

Chloride  of  Lead, 

Permanganate  of  Potash,           Liquor 

Sodae  Chlorinatrc, 

Antirheumatics, 

... 

102 

Macrotys, 

Sticta, 

Salicj'lic  Acid, 

Bryonia, 

Apocynum, 

Alkalies. 

Phytolacca, 

Acids, 

TABLE  OF  CONTENTS. 


Antiperiodics, 

Quinia  Sulph. 

Cinchonidia, 
Anti-erysipelatous, 

Veratrum, 

Apis, 
Restoratives, 

Air, 

Light, 

Exercise, 

Food, 

Tonics, 


Alstonia  Constricta 
Uvedalia, 


Arsenic, 
Nitric  Acid, 


Tinct.  Muriate  of  Iron,  Rhus, 
Sulphite  of  Soda, 


Iron, 

Phosphorus, 
Sulphur, 
Cod-Liver  Oil, 


Cuprum, 
Silica, 
Soda, 
Lime. 


PART     II. 

CARE  AND  MANAGEMENT  OF  INFANTS. 


VJLGK. 

105 


1C9 


111 


Chapter  III.— Washing  the  Child,    . 

.    119 

Clothing  the  Child,              .... 

120 

How  often  should  the  Child  be  Washed  ? 

.    121 

Attention  to  the  Cord,          .... 

122 

Ulceration  of  the  Umbilicus, 

122 

Excoriation  and  Chaffing,    .... 

123 

Does  the  Child  need  Medicine  after  Birth, 

.    123 

Difficulties  in  Nursing  the  Child,    . 

124 

Food  for  the  Child. 

.•   124 

Composition  of  Milk,             .... 

125 

Liebig's  Food,        .           .           .           . 

.    125 

A  Wet-Nurse,           .           : 

127 

Weaning  the  Child,         .           .           . 

.    128 

Sleeping,          ...... 

130 

Regular  Habits,    ..... 

.    131 

Moral  Government, 

132 

PART     III. 

DISEASES    OF    CHILDHOOD. 

Chapter  IV. — General  Symptoms  of  Disease,    . 

Physiological  Marriage,   .... 
Life  Line,  ..... 

Temperature,  Pulse,  Respiration, 


134 
.    135 

137 
.    137 


Xll 


TABLE  OF  C0NT£:NTS. 


Chapter  V.— Febrile  Diseases,           .... 

PAOB. 

.    140 

Pathology  of  Fever,             .... 

:           141 

Febricula,              ...... 

.    142 

Intermittent  Fever,              .... 

144 

Masked  Intermittent,       .           . 

.    149 

Remittent  Fever,                  .... 

149 

Slow  Infantile  Eemittent  Fever, 

.    156 

Congestive  Fever,                 .... 

160 

Continued  Fever,             ..... 

.    164 

"          Typhoid  Fever, 

167 

Spotted  Fever,                  ..... 

.    172 

Epidemic  Cerebro-Spin..l  Meningitis, 

178 

Diphtheria,             ...... 

.    183 

Eruptive  Fevers,                  .... 

190 

Variola — Small-Pox, 

.    192 

Varioloid,        .           .            .           .           .           . 

200 

Variola  Vaccina — Cow-Pox,       .... 

.    201 

Spurious  Vaccination,           .           .           ;           . 

205 

Can  Syphilis  be  transmitted  by  Vaccination  ? 

.    206 

Preservation  of  Vaccine,    .... 

207 

Rubeola — Measles,           ..... 

.    207 

Malignant  Rubeola,              .... 

209 

Scarlatina,              ...... 

.    212 

"         Anginosa,             .... 

213 

"         Maligna,           .           .           :           .           . 

.    214 

Pertussis,                   ..... 

221 

Parotitis,                ...... 

.    223 

Dyscrasias,                  ..... 

232 

Infantile  Syphilis,            .           .           .           :           : 

.    234 

Poisonous  Bites  and  Stings, 

240 

Chapter  VI. — Diseases  of  the  Respiratory  Apparatus, 

.    242 

Physical  Diagnosis,    ..... 

243 

Coryza,        ....... 

.    245 

Chronic  Catarrh,        ..... 

246 

"        Pharyngitis,        .            :           .           .           . 

.    250 

Tonsillitis,       ...... 

253 

Croup,                     ...... 

.    257 

"        Mucous,        ..... 

25V 

"        Pseudo-^Membranous,    .... 

.    261 

"        Spasmodic,               .... 

266 

TABLE  07  CONTENTS. 

tEdema  Glottidis, 

Bronchial  Catarrh,  ;  i  , 

Bronchitis,  Asthenic,  .  . 

*'  Acute,  .  .  , 

"  Chronic,  .  . 

Pneumonia,     .  .  .  ,  , 

Phthisis  Pulmonalis, 

Chapter  VII.— Diseases  of  the  Digestive  Apparatus 
Dentition  and  its  Derangements, 
Lancing  the  Gums, 
Care  of  the  Teeth, 
Second  Dentition, 
Stomatitis  Simplex, 
Aphthae, 
Stomatitis  Ulcerata, 

"  Gangrenous, 

Sore  Throat, 
Cynanche  Maligna,    . 
Chronic  Sore  Throat, 
Gastrodynia, 
Gastric  Irritation, 
Gastritis, 

Infantile  Dyspepsia, 
Colic, 
Diarrhoea, 
Muco-Enteritis, 
Cholera  Infantum, 
Tabes  Mesenterica, 
Dysentery, 
Constipation, 
Prolapsus  Ani, 
Intestinal  "Worms, 
Diseases  of  the  Liver, 
Congestion  of  the  Liver, 
Strumous  Enlargement  of  the  Liver 
Jaundice, 
Peritonitis, 
Hernia, 


xiu 

PAOB. 

268 
270 
272 
274 

278 
280 
285 

289 
289 
290 
291 
292 
293 
294 
297 
298 
300 
302 
305 
307 
308 
310 
312 
317 
319 
320 
322 
330 
333 
33G 
3:^ 

aio 
^e 

S48 
350 
354 
356 


XIV 


TABLE  OF  CONTENTS. 


Chapter  VIII. — Diseases  of  the  Urinary  Apparatus, 

PAGE. 

'      .    358 

Acute  Nephritis,                  .... 

358 

Chronic  Nephritis,            .           .           . 

.    361 

Albuminuria,             .           ;           .           .           . 

363 

Diabetes,               ....           .           . 

.    365 

Ischuria,        ...... 

367 

Enuresis,                ...... 

.    370 

Urinary  Calculi,         .           .           . 

372 

Imperforate  Urethra,                  .... 

.375 

Phymosis,        ...... 

376 

Paraphymosis,                   .           . 

.    377 

Urethritis,      ...... 

377 

Hydrocele,             ..;... 

.    378 

Infantile  Leucorrhoea,          .           .           :           . 

379 

Onanism,                ...... 

.    380 

Chapter  IX.— Diseases  of  the  Nervous  System, 

382 

Determination  of  Blood  to  the  Brain, 

.    383 

Congestion  of  the  Brain, 

384 

Phrenitis,               .           .           .           .           .           . 

.    385 

Acute  Hydrpcephalus,         .... 

391 

Chronic  Hydrocephalus,              .... 

.    395 

Spinal  Meningitis,                 .           .           .           . 

397 

Curvature  of  the  Spine,              .... 

.    400 

Epilepsy,         .           .           .           .           .           . 

405 

Convulsions,          ...... 

.    411 

Chorea,           ...:.. 

415 

Trismus  Nascentium,                  .... 

.    420 

Night  Terrors,           ..... 

421 

Paralysis,               ...... 

.    422 

Chapter  X.— Diseases  of  the  Eyes, 

424 

Ophthalmia  Neonatorum, 

.    425 

Diseases  of  the  Appendages  of  the  Eyes, 

427 

Furuncle,               ...... 

,    427 

Ptosis,             ...... 

427 

Trichiasis,              ...... 

•    428 

Diseases  of  the  Lachrymal  Apparatus, 

428 

Ophthalmi  Tarsi,              ..... 

.    430 

Catarrhal  Conjunctivitis,      .... 

432 

Opacity  of  the  Cornea,                .... 

.    435 

TABLE  OF  COXTEKTS, 


XV 


Chapter  XL— Diseases  of  the  Ears, 

PAGE. 

436 

Examination  of  the  Ear, 

•           • 

.    437 

Foreign  Bodies  in  the  Ear, 

438 

Earache,                 .            .           ; 

.    438 

Otitis, 

439 

Otorrhoea,              .            .           ^ 

.    442 

Deafness,         .           ,           .           . 

444 

Chapter  XII.— Diseases  of  the  Skin, 

.    448 

Exanthemata, 

449 

Erythema, 

.    450 

Roseola,          .           ,           .           . 

451 

Urticaria, 

.    453 

Erysipelas, 

455 

Vesiculae, 

.    458 

Milaria,           .           .           ,           . 

458 

Eczema, 

,    458 

Herpes,          ,           .           .           . 

:           461 

Scabies,                 .           .           : 

■»          • 

.    463 

Bulla*,             .           .           .           . 

466 

Pemphigus, 

•                                 •                            4 

.    466 

Rupia,            .           ,           ,      '      . 

;           467 

Pustulae, 

•                                 •                                 . 

.    469 

Ecthyma,        .           .           .           , 

469 

Porrigo, 

•                                 •                                 . 

.    471 

Papulae,          .           .           .           . 

473 

Lichen, 

•                                 •                                 « 

.    473 

Prurigo,          .           .           ,           . 

475 

Nasvus  Materai,               i 

*                                •                                 • 

.    476 

DISEASES  OF  CHILDREN. 


PA.RT     I. 

INFANTILE    THERAPEUTICS. 


CHAPTER     I. 


It  is  generally  admitted  that  there  are  sufficient  differences  in 
the  action  of  remedies  upon  the  adult  and  child  to  demand  a 
careful  study  of  the  subject.  While  all  practicing  physicians  are 
impressed  with  this  fact,  every  one  will  admit  the  difficulty  of 
making  the  distinction,  so  that  the  student  of  medicine  will  readily 
appreciate  it.  This  is  especially  true  of  the  older  treatment  by 
indirect  remedies,  which,  used  as  in  the  diseases  of  the  adult, 
were  very  uncertain  in  their  action  ;  but  in  the  special  or  specific 
medicines  the  difference  becomes  less  and  less,  as  we  thoroughly 
understand  their  action. 

These  differences  may  be  appropriately  classified  under  the  heads 
of:  Their  Action  upon  the  Nervous  System — upon  the  Organs 
of  Circulation  and  the  Blood — upon  the  Digestive  Tract,  and 
upon  the  Excretory  Organs. 

The  Nervous  System. — The  nerve  centers  of  the  child  are 
immature  and  more  easily  influenced  for  harm  than  in  the  adult. 
We  notice,  first,  that  they  are  very  easily  excited  (irritative),  and 
in  consequence  there  is  determination  of  blood.  The  immature 
structures  do  not  resist  this  morbid  influence  well,  hence  we  have 
excitation  of  function — restlessness,  wakefulness,  undue  expendi- 
ture of  nerve  force,  deranged  circulation  and  nutrition,  and  con- 
vulsions. 2 


I 

18  DISEASES   OF    CHILDPwKN. 

Second,  That  there  is  a  greater  tendency  to  impairment  of 
circulation  (stasis),  giving  rise  to  congestion  and  consequent  func- 
tional lesions.  In  this  case  structural  changes  take  place  rapidly, 
and  prove  a  frequent  cause  of  death. 

Not  only  is  there  this  tendency  in  disease  to  affect  the  nervous 
system  of  the  child,  but  many  remedies  influence  the  nervous 
system  in  these  ways.  As  we  progress  in  the  description  of 
remedies,  we  will  have  occasion  to  study  this  action,  and  will  here 
merely  cite  the  well-known  influence  of  opium  as  an  example. 

This  fact,  though  it  leads  us  to  great  caution  in  the  use  of 
remedies,  and  to  a  careful  observance  of  those  symptoms  which 
experience  has  shown  to  foreshadow  these  nervous  disturbances, 
points  out  the  course  of  therapeutic  study  likely  to  prove  most 
valuable.  As  all  processes  of  life  are,  to  a  greater  or  less  extent, 
under  the  influence  of  the  nervous  system,  we  may  so  guide  them 
by  medicinal  action  u|X)n  the  nerve  centers  as  to  remove  disease. 
This  subject  should  also  be  studied  with  reference  to  infantile 
hygiene.  Rest  to  the  nervous  system,  is  of  the  highest  importance 
to  the  young  child  ;  especially  is  this  the  case,  when  from  disease 
or  other  cause  there  is  an  imperfect  performance  of  the  functions 
of  digestion,  nutrition,  or  secretion. 

What  I  mean  by  rest  here  is,  an  avoidance  of  all  causes  of  irri- 
tation or  excitement,  whether  physical  or  mental.  In  a  case  there 
will  be  some  more  or  less  easily  removed  physical  irritation,  which 
it  is  the  duty  of  the  physician  to  point  out  to  the  mother,  and  if 
necessary  to  give  instructions  for  proper  management.  Frequently 
we  find  such  irritation  of  the  skin,  from  want  of  cleanliness,  or 
more  fVequently  from  too  frequent  and  hard  rubbings  with  an 
irritant  soap.  The  most  common  physical  irritation  is  from  con- 
fining the  child  with  its  clothing,  and  thus  preventing  a  li^althful 
change  of  position  and  the  natural  movements  of  its  limbs  and 
body.  In  the  proper  place  I  will  describe  what  I  deem  a  proper 
clothing  for  the  child. 

Most  persons  fail  to  appreciate  that  the  child  is  a  sentient 
being,  capable  of  receiving  mental  impressions  and  being  pleas- 
sin-ably  or  painfully  impressed  by  them.  If  I  should  say  that 
the  child  is  more  impressionable  than  the  adult,  receives  more 
pleasure,  suffers  more  pain,  and  that  both  influence  the  powers 
of  life  more,  I  would  but  state  the  case  as  it  presents  itself  to 
those  who  have  most  thoroughly  studied  children.  The  child  is 
helpless,  wholly  dei>endent  upon  the  care  of  iis  mother,  and  grows 


INFANTILE   THERAPEUTICS.  19 

into  conscious  life  in  an  atmosphere  of  love.     It  responds  pleas- 
uriibly  to  care   for  its  welfare,  and  suffers  acutely  from  neglect. 

We  frequently  meet  with  parents  who  seem  to  have  no  mental 
balance ;  now  they  are  the  most  loving,  then  they  are  harsh 
passionate,  and  wholly  without  reason.  In  sickness,  and  when 
occasion  offers  to  give  advice,  the  injury,  both  to  the  physical  and 
mental  welfare  of  the  child  should  be  pointed  out,  and  the  influ- 
ence of  the  physician  thrown  in  favor  of  a  systematic  effort  for 
self-government. 

In  some  diseases,  rest  to  the  nervous  system  is  absolutely  essen- 
tial to  life;  in  all  it  is  of  much  importance.  We  will,  therefore, 
carefully  guard  our  own  association  with  the  child,  that  it  may  not 
be  a  source  of  irritation,  calling  the  attention  of  parents  to  it,  and 
prescribing  remedies  with  reference  to  it.  The  good  old  times  of 
physic,  when  a  child  could  be  thrown  upon  his  back,  his  nose  held, 
and  the  nauseous  dose  forced  down  his  throat,  as  we  would  drench 
a  horse,  have  passed  by,  for  parents  have  learned  quite  as  soon  as 
physicians  that  it  is  not  necessary  to  a  cure. 

Teie  Circulatory  System  and  Blood. — Derangement  of 
the  circulation  forms  a  very  important  part  of  most  diseases  of 
children.  Very  slight  and  temporary  diseases  present  often 
marked  change  of  pulse,  while  in  the  more  grave  affections  it 
forms  the  basis  of  both  functional  and  structural  lesions. 

But  while  the  circulation  is  thus  easily  deranged  by  causes  of 
disease,  it  is  readily  reached  and  easily  amenable  to  remedies. 
Possibly  there  is  no  part  of  the  practice  of  medicine  that  will 
give  more  satisfaction  than  the  use  of  remedies  for  this  purpose. 

The  blood  of  the  child  seems  less  subject  to  zymotic  influences 
than  the  adult.  Typhoid  and  typhus  fever  are  of  very  rare 
occurrence,  and  epidemic  dysentery  and  like  affections  pass  the 
little  ones  by.  On  the  contrary,  the  susceptibility  to  the  eruptive 
fevers  is  greatest  in  early  life. 

Lesions  in  blood-making  are  common  in  childhood,  especially 
those  that  form  the  basis  of  that  protean  disease,  scrofula ;  true, 
the  lesion  may  be  primarily  of  the  lymphatic  system,  (Principles 
of  Medicine,  p.  236),  but  it  manifests  itself  in  imperfect  elabora- 
tion of  the  blood. 

Deficient  blood-making,  though  not  more  common  than  in  the 
adnlt,  is  less  easily  influenced  by  medicine.  Possibly  because  the 
diiroptivo  processes  can  not  be  stimulated  by  the  same  active 
tonic  medicines. 


20  DISEASES   OF    CHILDREN. 

The  Digestive  Apparatus. — ^The  digestive  tract  is  very  sus- 
ceptible to  the  action  of  irritants,  which  unfavorably  influence 
or  arrest  the  processes  of  digestion,  giving  rise  to  crude  and  im- 
perfect products,  and  deterioration  of  the  blood;  not  only  this, 
but  the  influence  upon  the  sympathetic  nervous  system  is  very 
marked,  and  is  sometimes  extended  to  the  cerebro-spinal  centers. 
A  very  common  as  well  as  marked  example  of  this  is,  convul- 
sions from  irritation  of  the  stomach  or  intestinal  canal.  I  have 
seen  the  most  severe  and  persistent  convulsions  produced  by  the 
administration  of  some  of  the  vermifuges,  and  even  from  castor  oil. 

There  is  a  less  marked  influence  upon  the  nervous  system  from 
irritation  of  the  intestinal  canal,  though  frequently  not  less  inju- 
rious. I  speak  of  that  which  manifests  itself  in  the  form  of 
nervous  irritability,  restlessness,  and  sleeplessness,  which,  as  we 
have  already  seen,  are  to  be  carefully  avoided. 

As  the  vegetative  functions  are  in  a  very  active  condition,  the 
child  sufiers  more  from  deprivation  of  food  than  the  adult.  It 
has  always  seemed  to  me  that  the  most  serious  error  in  the  treat- 
ment of  diseases  of  children,  was  the  use  of  such  means  as  would 
impair  the  power  of  the  stomach  to  digest  food,  and  destroy  the 
appetite.  Making  no  provision  for  a  supply  of  nutritive  material, 
the  waste  of  the  body  would  be  stimulated  to  excess,  and  the 
child's  life  rapidly  exhausted ;  using  a  homely  simile,  "  it  was 
burning  the  candle  at  both  ends." 

The  Excretory  Apparatus. — As  there  is  less  waste  of  tissue, 
the  excretory  organs  are  not  so  active  as  in  the  adult,  neither  do 
they  possess  the  power  of  sustained  activity  under  the  influence 
of  medicines.  While  it  will  be  found  quite  as  easy  to  temporarily 
increase  excretion,  it  requires  much  care  to  sustain  these  processes. 
Over  stimulation  frequently  leads  to  such  exhaustion  that  excretion 
is  almost  wholly  arrested,  and  the  little  patient  dies,  poisoned  by 
its  own  excreta. 

I  do  not  know  of  any  one  point  in  infantile  therapeutics  that 
is  more  essential  than  this,  in  the  more  grave  diseases.  Given,  a 
disease  that  will  require  one  or  two  weeks  for  its  progress,  and 
we  may  see  how  essential  it  is  that  the  daily  waste  of  tissue 
shoTild  be  prom])tly  removed.  And  we  can  never  afford  to  hazard 
the  successful  termination  of  such  disease,  for  the  uncertainty  of 
aborting  it  by  over  stimulation  of  the  excretory  organs. 


INFANTILE   THERAPEUTICS.  21 

DIRECT  MEDICATION. 

In  the  treatment  of  the  diseases  of  childhood  especially,  I 
prefer  direct  or  specific  medication,  as  I  do  iu  the  treatment  of 
the  adult;  but  I  find  more  directness  of  action  in  the  case  of  the 
child,  possibly  because  it  is  more  free  from  the  effects  of  a  false 
civilization. 

The  old  methods  of  indirect  medication  may  be  employed  when 
nothing  better  is  known,  but  iu  the  majority  of  cases  the  follow- 
ing rule  will  be  found  to  yield  the  greatest  success:  "Never  give 
a  dose  of  medicine  unless  you  see  clearly  the  indication  for  that 
particular  medicine,  and  have  a  reasonable  certainty  that  its  action 
will  be  beneficial."  Of  course,  this  cuts  off  hap-hazard  medica- 
tion, or  treating  the  name  of  a  disease,  and  if  persistently  followed, 

will  lessen  the  amount  of  medicine  administered  several  hundred 
per  cent. 

We  have  not  yet  specifics  for  every  disease,  possibly  for  no 
disease  in  its  totality,  but  we  have  specifics  for  pathological  con- 
ditions, and,  properly  employed  in  the  order  in  which  these 
pathological  conditions  take  precedence,  they  offer  a  direct  and 
very  certain  treatment  for  diseases. 

In  the  employment  of  remedies  we  find  greater  success  from 
doing  one  thing  at  a  time,  and,  as  a  general  rule,  from  the  use  of 
single  remedies  or  very  simple  combinations.  If  we  properly 
appreciate  the  different  parts  of  a  disease,  we  will  find  that  they 
hold  the  relation  to  one  another  of  cause  and  effect ;  that  there 
are  some  primary,  and  others  secondary  and  dependent  upon  the 
first ;  and  in  the  use  of  remedies  we  give  those  first  that  meet  the 
primary  lesion,  and  follow  with  such  as  reach  the  indications  of 
cure  in  the  order  named. 

In  the  treatment  of  diseases  of  children,  as  elsewhere,  there  is 
the  constant  tendency  to  view  the  sum  of  pathological  processes 
■as  a  unit,  and  to  meet  this  at  once.  Though  a  physician  knows 
well,  if  he  reflects,  that  recovery  will  occupy  days,  he  gives 
remedies  to  accomplish  it  in  hours.  All  the  remedies  that  would 
seem  to  be  indicated  in  the  whole  treatment  are  given  the  first 
and  each  succeeding  day. 

The  true  method  is,  to  make  a  thorough  analysis  of  the  disease, 
and  separate  it  into  its  component  parts;  determining  also  the 
order  of  these.  Then  remedies  are  selected,  not  with  reference  to 
the  name,  but  with  their  application  to  correct  a  clearly  under- 
stood pathological  change  of  function  or  structure. 


22  DISEASES   OF  CHILDREN. 

As  an  example,  I  may  take  iuflammmation  of  the  lungs.  On 
analysis  we  find  it  to  consist  of  an  accelerated  circulation,  increased 
temperature,  arrested  excretion,  difficult  respiration,  and  cough, 
and  more  or  less  excitation  of  the  nervous  system.  In  addition 
to  this,  there  is  impairment  of  the  digestive  functions,  and  a 
gradually  increasing  lesion  of  the  blood,  and  the  processes  of 
waste  and  nutrition.  Such  analysis  tells  us  what  the  disease  really 
is,  and  points  out  a  specific  or  direct  treatment. 

The  accelerated  circulation  is  controlled  by  the  use  of  veratrum, 
to  which  gelseminum  is  added  if  there  is  much  nervous  irritation. 
The  action  of  these  is  aided  by  the  general  bath,  hot  foot-bath, 
and  a  raush-jacket  to  the  chest,  which  also  relieves  the  irritation 
of  the  respiratory  organs.  Following  this,  if  necessary,  gentle 
diaphoretics,  diuretics,  and  laxatives  are  employed  to  stimulate 
secretion.  If  the  inflammatory  process  does  not  yield,  the  use  of 
inhalations  of  the  vapor  of  water,  or  a  s{>ecific,  like  small  doses 
of  ij>ecacuanha,  completes  the  cure.  In  the  meanwhile  any  gastro- 
intestinal irritation,  or  other  lesion,  passes  away  as  the  circulation 
becomes  normal  and  secretion  is  established. 

Very  many  times  it  requires  but  the  remedies  that  control  the 
circulation,  for  with  this  the  entire  series  of  morbid  phenomena 
gradually  disappears. 


CHAPTEE     TI. 
FORM  IN  WHICH  REMEDIES  SHOULD  BE  ADMINISTERED 


Success  in  the  treatment  of  diseases  of  children  will  depend 
much  upon  the  form  in  which  the  remedies  are  administered  The 
first  object  is  to  have  the  proper  medicine ;  tiie  second,  is  to  intro- 
duce it  into  the  circulation  without  exciting  any  morbid  process. 
It  matters  little  with  what  skill  the  disease  is  diagnosed,  or  the 
remedies  selected,  if  they  fail  to  gain  entrance  into  the  blood.  I 
doubt  not  that  any  physician  can  call  to  mind  cases  which  will 
verify  this  statement. 


FORM   OF   REMEDIES.  23 

The  form  of  a  medicine,  then,  is  very  important,  and  deserves 
our  careful  consideration.  The  remedy  should  not  be  objectionable 
to  the  tastC;  if  it  is  possible  to  avoid  it ;  for  the  unpleasant  taste 
excites  disgust,  followed  by  more  or  less  nausea,  and  during  this 
but  little  if  any  absorption  takes  place.  If  now  such  remedy  is 
re[>eated  every  one,  two,  or  three  hours,  the  disgust  and  nausea 
may  be  rendered  persistent,  and  the  remedies  fail  to  produce  the 
desired  effect,  because  they  do  not  get  into  the  circulation  where 
they  may  act. 

Many  remedies  undergo  decomposition  if  retained  in  the  stomach 
any  considerable  time,  and  either  lose  or  change  their  medical 
proj^)erties ;  hence,  anotlier  reason  for  proper  attention  to  the  form, 
as  well  as  some  other  accessories  to  their  proper  administration. 

Next  to  having  the  remedy  in  a  pleasant  form  is,  to  have  it  in 
tsolutioii  or  readily  soluble  in  the  gastric  fluids.  To  gain  entrance 
into  the  blood  it  must  be  in  perfect  solution,  and  as  time  is  an 
important  element  in  treatment,  it  is  well  to  see  that  the  remedy 
has  these  desirable  qualities  given  it  before  it  is  introduced  into 
the  stomach. 

I  prefer  tinctures  or  solutions,  and  usually  administer  them 
with  water.  A  very  good  method  is  to  prepare  the  remedy  in  a 
glass  of  water,  so  that  the  proper  quantity  will  be  contained  in  a 
teaspoonful.  I  find  that  the  slight  taste  is  not  objectionable, 
and  to  the  child  it  does  not  look  like  medicine.  If  the  child  is 
old  enough  to  observe,  I  prepare  it  in  his  presence,  showing  the 
bottles,  the  steps  of  the  process,  and  then  have  him  taste  it  and 
have  his  opinion  of  the  result.  In  this  way  I  find  no  difficulty 
in  competing  with  homoeopathy  as  to  the  pleasantness  of  medicine. 

The  mixing  of  medicines  in  compounds,  using  some  syrup  as  a 
vehicle,  and  attempting  to  disguise  the  taste  with  peppermint, 
cinnamon,  or  something  worse,  is  too  disgusting  now  for  the  well- 
trained  adult,  and  I  do  not  wonder  that  it  is  objectionable  to  the 
child.  I  am  very  free  to  confess,  that  rather  than  have  my 
children  dosed  with  nauseous  medicines,  however  good  might  be 
the  physician,  I  should  take  the  infinitesimal  nothing  of  the 
homoeopath,  and  trust  to  nature  for  a  cure. 

Powders  are  generally  more  objectionable  than  mixtures,  not 
only  on  account  of  their  taste,  but  the  difficulty  in  swallo\ving 
them,  and  their  unpleasant  influence  in  the  stomach.  They  are 
also  frequently  less  soluble,  and  are  absorbed  with  greater  difficulty. 

Syrups  are  not  so  objectionable  in  taste,  yet  frequently  the 


24  DISEASES   OF  CHILDREN. 

sugar  undergoes  decomposition  in  the  stomach,  producing  irrita- 
tion. They  are,  however,  very  uncertain  in  their  composition, 
and  hence  should  be  dispensed  with. 

Occasionally  we  may  employ  the  more  powerful  medicines  by 
the  use  of  homoeopathic  pellets.  They  are  easily  prepared,  but 
the  dose  is  minute  and  not  definite  in  quantity.  I  have  used 
aconite,  veratrum,  gelseminum,  strychnia,  morphia,  and  others  in 
this  form. 

Occasionally  we  may  administer  a  remedy  endermically  when 
it  can  not  be  given  by  mouth.  I  have  thus  used  quinia  in  inter- 
mittents  and  remittents,  morphia,  atropia,  aconite,  and  some  others. 
I  do  not  recommend  it  however  with  any-  but  the  first  two,  and 
the  use  of  these  will  hereafter  be  described. 

THE  DOSE  OF  MEDICINE. 

The  dose  of  medicine  should  be  as  small  as  will  give  the 
desired  result.  The  harsh  and  immediate  action  of  medicine  is 
not  usually  desirable,  but  rather  that  gentle  influence  which  is  in 
the  direction  of  healthy  action,  and  which  may  appropriately  be 
termed  physiological.  It  is  now  generally  admitted  that  the 
doses  of  medicine  have  been  much  too  large,  and  that  much  in- 
jury has  been  occasioned  by  this  over  medication  ;  but  there  is  no 
necessity  of  going  to  the  opposite  extreme  of  homoeopathy. 

In  this,  as  in  other  things,  there  is  a  happy  mean,  which  when 
found  gives  the  best  results.  The  doses  recommended  in  this 
work  are  the  maximum.  The  minimum,  though  not  infinitesimal, 
would  generally  be  regarded  as  too  small  to  produce  an  effect. 
The  human  body,  however,  is  a  very  delicate  mechanism,  and  its 
processes  most  easily  influenced,  and  we  may  readily  believe  that 
it  may  be  acted  upon  by  anything  of  positive  quality  and  appre- 
ciable quantity. 

A  considerable  experience  in  the  treatment  of  diseases  of 
children,  has  convinced  me  that  the  various  processes  of  life  are 
influenced  with  more  certainty,  and  with  far  less  liability  ot  injury, 
through  the  sympathetic  system  of  nerves,  and  that  a  very  gradual 
influence  is  far  more  desirable  than  a  speedy  one. 

Another  very  important  ])oint  in  infantile  therapeutics  is,  that 
the  medicinal  influence  be  continued  until  the  desired  result  is 
obtained.  In  other  words,  that,  as  the  ultimate  object  is  to  be 
slowly  obtained,  and  that  by  repetitions  of  the  remedy,  graduiilly 


CLASSIFICATION   OF  EEMEDIES.  25 

increasing  its  influence  from  dose  to  dose,  the  doses  should  be  so 
frequently  repeated  as  not  to  lose  the  influence  of  one  before 
another  is  given. 

Medicine  should  never  be  left  for  the  sick  to  be  given  in  drops, 
especially  with  children,  who  would  suffer  most  from  deviation 
in  this  respect.  Let  the  remedy  be  added  to  some  vehicle — water 
is  the  best — so  that  the  dose  will  be  a  teaspoonful.  I  have  had 
one  patient  poisoned  from  neglect  of  this  rule,  and  others  injured, 
hence  I  place  much  stress  upon  it.  There  is,  however,  another 
reason  for  such  dilution  which  may  have  some  bearing  ;  and  that 
is,  the  medicine  is  placed  in  a  form  that  it  can  be  more  readily 
absorbed. 

CLASSIFICATION  OF  REMEDIES. 

The  classification  of  remedies  is  a  work  of  no  little  difficulty, 
if  we  are  to  study  them  according  to  their  specific  action,  which  is 
the  only  method  that  will  advance  the  practice  of  medicine.  In 
the  treatment  of  diseases  of  children,  at  least,  we  will  abandon 
the  old  methods  of  large  doses  with  their  poisonous  effects,  and 
substitute  the  small  dose  of  pleasant  medicine,  kindly  in  its  in- 
fluence upon  the  body,  and  directly  antagonistic  to  the  processes 
of  disease. 

The  old  practice  never  gave  good  success.  It  added  additional 
pangs  to  the  suffering,  new  wrongs  to  those  existing,  prolonging 
the  duration  of  disease  and  increasing  its  mortality.  A  purely 
expectant  practice  has  proven  far  more  successful ;  good  nursing 
with  diet  and  rest  has  given  much  better  success;  the  water-cure 
has  yielded  better  results,  and  homoeopathy  has  proven  an  incal- 
culable blessing  to  the  suffering  little  ones. 

Whilst  we  administer  remedies  for. the  most  part  according  to 
specific  indications — special  symptoms  pointing  out  the  remedies 
— some  are  given  for  their  well-known  physiological  action,  and 
because  they  influence  special  parts  in  a  well-known  way.  A 
large  number  of  our  remedies  may  be  classified  according  to  their 
action  upon  special  parts  or  functions,  and  I  can  not  but  think 
that  such  grouping  will  be  of  advantage. 

W.e  will,  therefore,  study  our  remedies  as — 1.  Those  which  in- 
fluence the  nervous  system  ;  2.  Those  which  influence  the  circu- 
lation; 3.  Those  which  influence  the  temperature;  4.  Those 
which  influence  the  respiratory  apparatus;  5.  Those  which  in- 
fluence the-  digestive  apparatus;    6.  Those  which  influence   the 


26  DISEASES  OF  childre:n. 

urinary  apparatus  and  its  secretion ;  7.  Those  which  influence 
the  skin  and  its  function;  8.  Those  which  oppose  the  malarial 
poison — antiperiodics;  9.  Those  which  oppose  the  process  of 
zymosis — anti-zymotics  ;  10.  Those  which  oppose  the  process  of 
sepsis — anti-septics ;  11.  Those  which  oppose  rheumatism — anti- 
rheumatics; 12.  Those  which  oppose  the  poison  of  crysipelous — 
auti-erysipclatous;  13.  Those  which  oppose  the  syphilitic  poison — 
anti-syj)hiiitic,  and  14.  Agents  that  promote  the  processes  of 
nutrition  and  increase  life. 

REMEDIES  WHICH   INFLUENCE    THE   NEEVOUS  SYSTEM. 

Gelseminum,  Quinine,  Bromide  of  Ammonium, 

Belladonna,  Opium,  Carbonate  of  Ammonia, 

Rhus,  Phosphorus,  Iodide  of  Ammonium, 

Bryonia,  Camphor,  Ferro-cyanuret  of  Potassium, 

Lobelia,  >^ther,  (Enotbera, 

Pulsatilla,  Chloroform,  Asafcetida 

Nux  vomica.  Chloral, 

As  has  been  already  remarked,  "  the  nerve  centers  of  the 
child  are  immature  and  more  easily  influenced  for  harm  than  in 
the  adult."  It  might  also  be  stated  that  the  nervous  system  of 
the  child  suffers  more  from  disease,  and  remedies  influencing  it 
assume  a  more  important  place  in  infantile  than  in  adult  thera- 
peutics. It  would  sometimes  seem  as  if  the  old  doctrine — "  that 
all  diseases  have  their  origin  in  wrongs  of  innevratiou  " — was  more 
than  truth;  at  least,  our  acting  upon  it  would  be  more  nearly 
right  than  he  who  is  always  "  acting  upon  the  bowels." 

The  influence  of  the  nervous  system,  even  the  brain,  upon  the 
processes  of  vegetative  life,  is  much  more  marked  than  in  the 
adult,  and  the  relief  of  a  wrong  of  innevration  will  many  times 
occur,  when  remedies  directed  to  the  disease  as  classified,  have 
no  effect.  Instances  will  continually  come  up  in  practice,  when 
single  remedies  like  Rhus,  Gelseminum,  Belladonna,  Bryonia, 
etc.,  are  sufficient  for  the  cure  of  seemingly  complex  diseases. 

The  evidences  of  disease  here  will  soon  become  plain  to  the 
careful  observer,  as  he  studies  the  position  of  the  body,  its  move- 
ments and  expression,  the  expression  of  the  face,  its  color,  the 
expression  of  the  eyes,  color,  dryness  and  moisture,  dilation  or 
contraction  of  pupil,  temperature,  and  the  frontal,  orbital  and 
facial  expression  of  pain.  We  do  not  claim  that  this  is  to  be 
learned  in  a  day  or  a  year,  but  it  will  be  learned  in  a  satisfactory 
degree  by  him  who  gives  it  his  attention. 


CLASSIFICATION  OF  EEMEDIES.  27 

If  now,  we  take  some  common  examples,  we  may  see  the  trnth 
of  the  above.  For  instance,  here  is  a  patient  (a  grave  case  of 
disease)  wlio  is  restless,  starts  iu  sleep,  cries  out  suddenly  and 
shrilly  ;  we  look  at  the  face,  which  is  contracted,  especially  about 
the  eyes  or  base  of  the  brain ;  the  eyes  are  bright,  and  evidently 
the  little  patient  suffers  pain,  as  shown  by  the  contraction  of  the 
frontal  and  orbital  muscles.  We  give  Rhus  iu  small  doses,  and  all 
the  unpleasant  symptoms  fade  away.  Here  is  another,  suifering 
from  fever  or  inflammation,  which  shows  a  flushed  face,  bright  eyes 
and  contracted  pupils,  with  increased  heat ;  there  is  restlessness, 
sleeplessness,  it  may  be  threatened  convulsions,  and  thinking  of 
the  usual  means,  it  is  a  bad  case.  We  admisister  Gelseminura 
with  Aconite,  and  there  is  speedy  and  marked  amendment.  In 
still  another,  we  find  the  patient  dull,  sleepy,  comatose ;  the  eyes 
dull,  pupil  dilated,  and  it  may  be  a  dull  or  dusky  coloration  of 
skin.  We  give  Belladonna  and  these  unpleasant  symptoms  soon 
pass  away,  and  the  patient  convalesces.  In  another,  the  twitching 
of  the  facial  muscles,  the  sudden  movement  of  the  head,  and  the 
involuntary  movement  of  the  extremities  indicate  the  tendency 
to  convulsions;  the  face  is  pale,  brow  contracted,  circulation 
feeble,  and  we  administer  bromide  of  ammonium  with  a  certainty 
of  removing  the  unpleasant  symptoms. 

Gelseminum.  Specfiic  Indications. — The  face  is  flushed,  eyes 
bright,  pupils  contracted,  temperature  increased,  nervous  system 
excited,  patient  restless  and  wakeful. 

Dose. — I^  Tinct.  Gelseminum,  gtt.  v.  to  gtt.  xx.,  water  5iv.; 
a  teaspoonful  every  hour.  When  the  irritation  is  very  great 
and  the  patient  is  threatened  with  convulsions  the  dose  can  be 
increased. 

Homoeopathic  Indications,  (3d  to  6th  decimal). — Bad  effects 
from  fright  and  fear,  fright  causes  diarrhoea ;  vertigo  with  loss 
of  sight,  chilliness,  accelerated  pulse,  double  vision ;  great  heavi- 
ness of  the  eyelids;  paralysis  of  the  eyelids  and  other  parts; 
pupils  dilated;  dull  expression  of  countenance  ;  difficult  articula- 
tion and  deglutition  ;  neuralgia,  sharp,  shooting  pains  through  the 
face,  eyes  and  head.  Scarlet  fever  with  great  nervous  excitement, 
tonsils  swollen  and  very  red,  pulse  rapid. — Ehrmann. 

We  use  a  saturated  tincture  of  the  green  root ;  all  other  prepa- 
rations are  imperfect  or  wholly  worthless  for  the  purposes  for 
wliich  we  employ  it.     The  difficulty  in  describing  this,  as  well 


28  DISEASES   OF  CHILDREN. 

as  some  other  remedies,  so  that  the  practitioner  can  employ  them 
with  success  is,  the  very  great  difference  in  the  quality  of  the 
article,  as  sold  by  different  druggists. 

Gelseminum  exerts  an  influence  on  the  circulation  like  vera- 
trura  and  aconite,  but  less  marked,  and  not  so  certain,  and  it  is 
not  for  this  purpose  that  I  employ  it.  It  has  a  specific  action 
upon  the  cerebro-spinal  nerve  centers,  relieving  irritation  and 
determination  of  blood  to  these  parts.  This  is  a  use  that  renders 
the  Gelseminum  a  remedy  of  great  value  in  treating  the  diseases 
of  childhood.  The  action  is  so  certain  and  definite,  that  we 
prescribe  the  remedy  with  great  satisfaction.  Given,  a  case  of 
fever  or  inflammation,  in  which  the  child  is  uneasy,  irritable  and 
restless,  the  face  is  flushed,  the  eyes  bright,  the  pupils  contracted, 
and  head  hot,  Gelseminum  removes  in  a  few  hours  all  the  un- 
pleasant symptoms. 

It  is  also  one  of  our  most  valued  antispasmodics.  Its  use  is 
in  those  cases,  in  which  the  convulsions  are  due  to  irritation  of 
the  cerebro-spinal  centers.  In  a  case  of  acute  disease,  the  child 
presenting  those  involuntary  twitchings  of  the  muscles  which 
indicates  the  approach  of  convulsions,  there  being  the  flushed 
face,  bright  eyes,  and  irritability,  Gelseminum  wards  off  the  ap- 
proaching spasms,  and  relieves  the  child  of  them  when  they  have 
appeared. 

Gelseminum  also  has  an  important  action  on  the  urinary  organs, 
which  it  is  well  to  notice  here.  Occasionally  a  case  of  dysuria 
will  be  met  with,  consequent  upon  irritation  of  the  neck  of  the 
bladder  or  spasmodic  stricture  of  the  urethra.  Gelseminum  will 
overcome  the  obstruction  and  cause  a  flow  of  urine,  in  a  majority 
of  cases. 

Belladonna.  Specific  Indications. — The  patient  is  dull, 
drowsy,  comatose,  dull  heavy  headache,  the  face  dull  and  expres- 
sionless, the  eyes  dull,  pupils  dilated  or  immobile,  capillary  circu- 
lation sluggish,  as  marked  by  deep  color  of  skin  or  redness  that 
is  effaced  by  pressure  of  the  finger,  which  leaves  a  somewhat  per- 
sistent white  line.  Passage  of  large  quantities  of  limpid  urine, 
involuntary  passages  of  urine. 

Dose. — I^  Tinct.  Belladonna,  gtt.  v.  to  gtt.  x.,  water  Siv. ;  a 
teaspoonful  every  one  to  three  hours. 

HomoeopaiMc  Indications,  (3d  to  6th  decimal). — Throbbing 
headache,  with   congestion  of  blood  to  the  head,  vertigo,  pulsa- 


CLASSIFICATION   OF   EEMEDIES.  29 

tion  of  the  carotids,  worse  from  motion,  light  and  noise  are  intol- 
erable; furious  delirium,  illusions,  hallucinations,  with  flushed 
face  and  redness  of  the  eyes;  wishes  to  strike,  bite  or  shriek, 
}3U})ils  dilated,  eyes  brilliant  and  staring;  smooth,  shining  redness 
of  the  skin,  hot,  burning  and  itching;  sore  throat,  with  sensa- 
tion of  a  lump  on  swallowing,  and  great  dryness  of  the  throat ; 
involuntary  discharges  of  feces  and  urine  from  paralysis  of  the 
sphincters;  pains  come  on  suddenly,  and  leave  just  as  suddenly. 
—  Ehrmann. 

Belladonna  causes  contraction  of  capillary  blood-vessels,  doubt- 
less by  stimulation  through  the  sympathetic  nervous  system. 
Hence  it  is  the  remedy  for  congestion.  Stasis  of  blood,  or  con- 
gestion, occurs  in  dilated  capillary  blood-vessels;  indeed  this 
condition  of  the  capillaries  is  the  cause  of  congestion.  This 
action  of  Belladonna  was  first  observed  by  Brown-Sequard  in 
some  of  his  physiological  investigations. 

While  this  influence  is  exerted  upon  the  entire  circulation,  it 
is  most  marked  upon  the  circulation  of  the  nerve  centers.  Thus 
we  regard  Belladonna  as  specific  to  congestion  of  the  brain  and 
spinal  cord,  and  the  dullness  and  coma  which  are  symptomatic  of 
it.  In  this  respect  Belladonna  is  the  opposite  of  Gelseniinum, 
which  removes  irritation  and  lessens  determination  of  blood,  the 
condition  being  an  active  one. 

Rhus  Toxicodendron.  Specific  Indications. — The  patient  is 
restless,  starts  suddenly  in  sleep,  sudden  sharp  cry,  contraction 
of  muscles  about  eyes  and  at  base  of  brain,  sharp  frontal  pain, 
especially  in  left  orbit,  small  pulse  with  sharp  stroke,  tongue 
shows  small  red  papillae  at  the  tip,  erythematous  flushing  of  sur- 
face, small  vesiculoe  about  mouth  and  sometimes  upon  the  skin. 

Dose. — I^  Tinct.  Rhus,  gtt.  v.,  water  5iv.;  a  teaspoonful  every 
hour. 

Homoeopathic  Indiations,  (3d  to  6th  decimal). — Great  debility, 
feeling  of  soreness  and  lameness  of  the  muscles,  especially  when 
at  rest.  Rheumatic  pains,  drawing  and  tearing  in  the  muscles 
and  joints.  Stiffness  of  the  joints,  relieved  by  continuous 
motion.  Paralysis  of  the  limbs.  Bad  effects  from  getting 
wet.  Putrid  taste  in  the  mouth,  metallic  taste.  Very  restless 
sleep  before  midnight.  Violent  stretching  and  yawning.  Diar- 
rhoea, stools  watery  or  of  bloody  mucus,  frothy  or  white.  Invol- 
untary stools  at  night  while  asleep.     Dysentery  with  nausea  and 


80  DISEASES  OP  CHILDREN. 

tenesmus.  Involuntary  discharge  of  urine.  Typhoid  fever,  dull 
stupid  expression  of  the  face,  muttTering  delirium.  Tongue  dry, 
red,  smooth.  Restlessness.  Involuntary  passage  of  stools  and 
urine,  great  exhaustion.  Erysipelas  with  intense  itching  and 
burning.  Scarlet  fever  or  small  pox  before  the  eruption  itches  a 
great  deal,  with  restlessness.     Pustulous  eruptions. — Ehrmann. 

This  has  a  very  extended  use  in  the  treatment  of  diseases  of 
children.  Commencing  with  the  cases  in  which  cerebral  disease 
is  a  prominent  complication,  or  indeed  the  principal  element  of 
disease,  we  find  that  this  remedy  relieves  the  excitement,  pro- 
motes normal  innervation  through  the  sympathetic,  and  thus 
restores  the  circulation,  waste  and  nutrition  of  the  brain.  It  not 
only  releives  the  brain  and  spinal  cord,  but  it  exerts  a  marked 
influence  upon  the  circulation  of  blood,  upon  the  temperature, 
upon  waste  and  secretion,  and  upon  nutrition.  It  presents  us 
one  of  the  most  marked  examples  of  the  truth  of  the  therapeutic 
maxim,  "  where  a  remedy  is  specially  indicated,  it  will  favorably 
influence  every  function  of  life,  and  sometimes  do  every  thing 
that  needs  be  done  to  effect  a  cure." 

Thus  a  malarial  fever  having  the  pronounced  indications  for 
Rhus  will  be  cured  by  it  better  than  by  Quinine.  An  inflamma- 
tion of  the  eyes,  of  the  lungs,  of  the  bowels,  of  the  urinary  appa- 
ratus, or  of  any  part,  yields  readily  to  Rhus,  when  it  is  specially 
indicated. 

It  is  a  remedy  frequently  demanded  in  erysipelas  and  erysipeloid 
diseases,  in  zymotic  and  typhoid  fevers,  and  in  many  endemic  and 
epidemic  diseases  of  children.  Its  use  in  the  eruptive  fevers,  and 
in  diseases  of  the  skin  will  be  named  hereafter. 

Bryonia.  Specific  Indications.  Headache  in  right  side,  with 
flushed  right  cheek ;  pain  in  serous  cavities,  with  tension  of 
muscles,  and  moderate  tenderness  on  pressure  ;  sharp,  lancinating 
pain,  with  tension  of  tissues;  hacking  cough  with  pain;  dry 
skin,  sensitive  ;  hard  pulse,  with  moderate  fullness,  sometimes 
corded  ;  rheumatic  pain. 

Dof^e. — !^  Tinct.  Bryonia  gtt.  v.  to  gtt.  x.,  water  Siv.;  a  tea- 
spoonftil  every  hour. 

Homoeopathic  Indications  (3d  to  6th  decimal). — In  rheumatism 
and  other  complaints,  marked  aggravation  on  the  slightest  motion, 
feels  best  when  quiet;  typhoid  fever,  with  dry  mouth  and  lips, 
tongue  is  dry,  rough,  and  cracked,  and  of  a  dark  brown  color  ; 


CLASSIFICATION  OF  REMEDIES.  31 

delirium  at  night  of  the  business  of  the  day;  patient  wants  to  go 
home  ;  urine  dark  with  pinkish  sediment ;  pneumonia  and  pleu- 
risy, with  sharp  stitching  pains  on  motion  or  breathing  deeply  ; 
cou";h  worse  in  warm  room. — Ehrmann. 

Bryonia  will  be  found  a  prominent  anti-rheumatic,  and  also  a 
remedy  for  pain,  especially  when  the  pain  is  increased  by  pressure. 
Physiologically  it  has  been  found  to  exert  a  special  influence  upon 
serous  membranes,  and  when  our  little  patient  complains  of  pain 
in  the  articulations,  abdominal  pain  with  tenderness,  pleuritic  pain, 
headache,  with  tenderness  of  the  eyes  and  temporal  regions,  ten- 
sive pain  in  the  ears,  we  think  of  this  remedy. 

It  is  a  prominent  remedy  in  disease  of  the  respiratory  apparatus 
— the  cough  irritative,  hacking  or  rasping,  pleuritic  pain,  sore- 
ness as  if  the  parts  were  bruised,  or  soreness  and  tenderness  of 
larynx  and  supra-sternal  notch.  It  does  not  matter  whether  the 
disease  is  pneumonia  or  bronchitis,  the  Bryonia  acts  well. 

I  wish  especially  to  call  attention  to  the  abdominal  pain  and 
tenderness  in  typho-raalarial  fever,  and  in  some  zymotic  diseases, 
as  calling  for  this  remedy.  It  may  also  be  associated  with  Ipecac 
or  Euphorbia  in  cholera  infantum,  when  there  is  abdominal  ten- 
sion and  tenderness,  or  swelling  and  pain  of  articulations. 

Bromide  of  Ammonium.  Specijio  Indications. — Sudden  move- 
ments of  body  or  extremities,  jerking  of  the  tendons,  twitching  of 
the  facial  muscles,  want  of  accommodatoin  in  the  eyes,  eyes 
turned  upward  ;  face  unusually  pale,  and  pulse  small,  though  I 
should  not  be  guided  by  this. 

Dose. — For  a  child  one  to  two  years  of  age,  I  would  prescribe, 
5j-  to  oij-  to  water  .^iv.;  a  teaspoonful  sufficiently  often  to  control 
the  symptoms  and  give  rest. 

I  employ  bromide  of  ammonium  to  relieve  the  irritation  of 
the  brain  and  spinal  cord,  which  gives  rise  to  convulsions.  It 
may  be  used  to  prevent  the  occurrence  of  convulsions  when 
threatened,  or  to  prevent  their  recurrence  when  arrested  by  other 
means.  Regarding  the  remedy  as  a  stimulant  to  the  nerve  cen- 
ters, we  would  use  it  when  there  was  evidence  of  an  enfeebled 
circulation  of  blood  to  the  brain. 

There  are  a  few  cases  of  whooping  cough  in  which  bromide  of 
ammonium  will  be  found  curative.  In  these  there  is  an  epilepti- 
form  movement  of  muscles  of  the  extremities  associated  with 


32  DISEASES   OF  CHILDREN. 

the  cough,  and  even  the  convulsive  movements  of  the  chest  may 
be  distinct. 

When  convulsive  disease  has  assumed  a  chronic  form,  as  in 
epilepsy,  I  regard  the  bromide  of  ammonium  as  one  of  our  most 
certain  remedies.  Its  influence  in  childhood  is  more  marked 
than  in  the  adult.  And  its  curative  action  is  of  course  greater 
at  the  commencement  of  the  disease  than  when  it  has  continued 
for  several  years.  I  have  employed  it  in  a  large  number  of 
cases  of  epilepsy,  with  very  good  success,  a  permanent  cure  re- 
sulting in  a  fair  proportion. 

Pulsatilla.  Specific  Indications. — The  child  is  restless, 
weary,  cries  frequently,  sobbing  even  in  sleep,  face  pale  and  ex- 
pressionless, pulse  small  and  feeble. 

Dose. — ^  Tinct.  Pulsatilla  gtt.  v.,  water  .^iv.,  a  teaspoonful 
every  three  or  four  hours. 

Homceopathic  Indications,  (3d  to  6th  decimal). — Mild,  yield- 
ing disposition,  with  inclination  to  shed  tears.  Vertigo  when 
stooping  or  lifting  up  the  eyes.  The  pains  of  pulsatilla  con- 
stantly change  their  position,  flying  from  one  part  to  another. 
Painful  inflammation  of  the  eyes,  styes,  lachrymation  in  the  wind. 
Dryness,  burning  and  itching  of  the  eyes  and  lids,  with  inclina- 
tion to  wipe  something  away.  Fistula  lachrymalis.  Obscura- 
tions of  the  cornea.  Otalgia,  darting,  tearing  pains.  Discharge 
of  mucus  or  pus  from  the  ear.  Measles  with  loose,  rattling 
cough,  photophobia,  thick  and  yellowish  coryza. — Ehrmann. 

Lobelia.  Specific  Indications. — The  pulse  is  full  and  oppressed, 
breathing  difficult,  rattling  of  mucus  in  chest,  dull  expressionless 
face.  Dull  eyes,  somewhat  swollen,  threatened  convulsions,  rest- 
lessness with  uneasiness  of  bowels. 

Dose. — The  dose  will  vary  from  the  usual  gtt.  v.  to  water  Siv., 
a  teaspoonful  every  hour,  to  that  which  will  prove  nauseant  or 
emetic.  To  relieve  restlessness  and  pain,  and  improve  the  circula- 
tion and  respiration  the  old  prescription — I^  Tinct.  Lobelia  Sem. 
5j-,  Comp,  Spirits  Lavender  3iij-,  Simple  Syrup  .5iss. — will  be 
found  very  good. 

Homceopathic  Indications,  (3d  to  6th  decimal). — Nausea  and 
vomiting,  witli  flow  of  saliva;  sensation  of  a  lump  in  the  throat, 
impeding  swallowing;  asthma  with  burning  feeling  in  the  chest 
and  tightness;  urine  deep  red  color. — Ehrmann. 


INFANTILE    THERAPEUTICS.  33 

Many  of  our  readers  will  recall  the  old  treatment  of  convul- 
sions in  which  Lobelia  played  so  important  a  part  as  an  antispas- 
modic. Compound  Tincture  of  Lobelia  and  Capsicum  (King's 
antispasmodic)  was  advised  in  all  cases,  and  physicians  would 
often  wonder  why,  when  the  little  fellows  were  so  thorougiily 
drenched  with  this  nastiness,  the  convulsions  would  sometimes 
persist  even  to  a  fatal  termination.  It  was  the  old  error  of 
prescribing  for  names  instead  of  conditions.  Tlie  Lobelia  is  a 
powerful  antispasmodic,  the  conditions  being  as  above  named — 
an  oppressed  circulation.  It  is  a  stimulant  to  the  brain  and 
spinal  cord,  to  the  respiratory  system,  and  to  the  ganglionic 
nerves.  If  the  condition  of  the  nervous  system  in  convulsions 
is  such  as  to  require  a  stimulant,  then  Lobelia  is  a  remedy. 

To  quiet  irritation  of  the  nerve  centers  and  give  rest,  the 
remedy  must  be  given  in  doses  less  than  nauseant,  and,  as  above 
remarked,  it  may  be  combined  with  an  aromatic,  or  alternated 
with  Aconite  or  Nux.  It  also  relieves  irritation  of  the  stomach 
upon  which  the  restlessness  many  times  depends. 

Nux  Vomica.  The  child  is  restless,  draws  up  its  legs,  con- 
torts its  body,  screams  violently,  wakes  suddenly  from  sleep 
with  crying,  face  flushes — intestinal  irritation,  colic,  increased 
nervous  sensibility.  The  face  is  pallid,  sallow,  yellowness  about 
mouth,  tongue  pallid,  nausea  and  vomiting,  child  uncomfortable, 
restless,  sleepless,  pallid,  expressionless  face  and  tongue,  food 
distresses  it,  urine  free  but  high  colored,  colors  the  napkins. 

Dose. — I^  Tinct.  Nux  gtt.  j.  to  gtt.  iij.,  water  5iv.;  from  one- 
fourth  to  one  teaspoonful  every  half-hour  or  hour. 

Homoeopathic  Indications,  (3d  to  6th  decimal). — Irritable ; 
inclined  to  find  fault,  disinclined  to  talk;  wants  to  be  let  alone; 
nausea  and  vomiting;  constipation,  large  difficult  stools;  uneasy 
feeling  as  if  the  bowels  ought  to  move;  ineffectual  effbrts  to  pass 
the  feces ;  painful  hemorrhoids ;  loss  of  appetite ;  restless  sleep, 
wakes  at  3  a.  m.  ;  eructations  and  heart-burn  ;  violent  hiccough  ; 
colic  of  whisky  and  coffee  drinkers ;  can  not  bear  the  clothing 
tight  around  the  waist ;  incarcerated  hernia ;  dysentery,  stools 
small  and  frequent,  with  ineffectual  urging;  retention  of  urine; 
suitable  to  persons  of  sedentary  habits. — Ehrmann. 

Nux  undoubtedly  relieves  irritation  of  the  brain  and  spinal 
cord,  when  the  circulation  to  these  centers  is  enfeebled.  One 
3 


34  DISEASES   or   CHILDREN. 

might  think,  from  its  kindly  action  upon  the  intestinal  canal  and 
associated  viscera,  that  the  relief  depends  wholly  upon  tliis,  but  I 
am  satisfied  that  it  is  not  so.  When  the  face  is  pallid  and  the  pulse 
feeble,  I  have  seen  it  relieve  the  patient  from  threatened  con- 
vulsions, give  rest  and  good  sleep. 

In  infantile  paralysis,  imperfect  movement,  and  want  of  de- 
velopment of  the  extremities,  it  is  a  remedy  to  be  thought  of  if 
the  circulation  is  feeble.  When  the  respiratory  movements  are 
feeble,  in  malarial  disease,  I  would  suggest  Nux.  It  is  not  so 
important  in  retention  of  urine  as  santonine,  but  it  may  occa- 
sionally be  used  with  advantage. 

It  is  the  tonic  of  childhood,  or  rather  the  stomachic;  for  it  is 
kindly  received  by  the  stomach  and  is  not  as  objectionable  to  the 
taste  as  the  most  of  bitters,  while  it  increases  the  appetite  and 
the  power  to  digest  food. 

When  there  is  great  depression  of  the  nervous  system,  without 
fever  or  inflammation,  it  may  be  used  with  advantage.  As  an 
adjuvant  to  qninia  in  periodic  disease,  especially  in  intermittent 
fevers,  strychnia  will  serve  a  good  purpose,  and  in  some  old 
cases,  where  quinia  has  been  used  to  excess,  we  may  arrest  the 
periodic  disease  by  its  use. 

Quinia  Sulphas.  Specific  Indications. — There  is  distinct 
periodicity  in  the  disease.  When  administered  the  pulse  should  be 
soft,  the  skin  soft  or  inclined  to  moisture,  the  tongue  moist  and 
cleaning,  and  the  nervous  system  moderately  free  from  irritation. 

Dose. — The  antiperiodic  dose  of  quinine  may  be  stated  at  one 
grain  for  each  year,  a  grain  being  the  dose  for  a  child  six  months 
old.  This  proportion  will  continue  up  to  the  sixth,  eighth  or 
tenth  year,  when  it  will  stop  until  after  puberty.  In  many  cases 
the  antiperiodic  influence  of  quinine  may  be  obtained  from  a 
minute  dose,  or,  as  we  frequently  use  it,  from  its  application  to 
the  skin  by  inunction. 

Homceopathic  Indicationn,  (3d  to  6th  decimal). — Great  debility 
resulting  from  loss  of  fluids,  as  in  diarrhoea,  hemorrhage,  etc.; 
ailments  which  have  a  marked  periodicity;  metorrhagia,  with 
paleness  of  the  face  and  coldness  of  the  skin  ;  pulse  impercepti- 
ble; rinjring  in  the  ears;  diarrhoea,  painless  and  debilitating, 
stools  nndi<::ested,  worse  after  eating  or  at  night;  intermittent 
fever,  followed  by  profuse  and  debilitating  perspiration ;  sensi- 
tive to  the  least  draft  of  air. — Erhmann. 


INFANTILE   THERAPEUTICS.  36 

Many  wrongs  of  innervation  will  be  found  to  have  distinct 
periodicity,  whether  they  take  the  form  of  pain,  restlessness, 
sleeplessness  or  tendency  to  convulsive  action.  In  malarial  re- 
gions the  practitioner  is  continually  on  the  watch  for  this,  and 
even  an  obscure  periodicity  is  thought  to  demand  quinine,  and 
its  right  use  is  followed  by  most  satisfactory  results. 

Quinine  has  been  regarded  as  a  tonic  and  a  nerve  stimulant, 
but  these  actions  are  doubtful  unless  there  is  the  specific  indica- 
tion. The  inunction  of  quinine  is  frequently  followed  by  in- 
creased appetite  and  digestion,  a  restful  nervous  system  and 
better  excretion,  and  patients  recover  rapidly  from  cholera  infan- 
tum, slow  forms  of  inflammation  and  obscure  diseases,  but  I 
think  in  each  of  these  cases  a  careful  examination  would  deter- 
mine the  malarial  infl.uence  and  periodicity. 

Ergot.  Specific  Indications. — Dullness,  stuix)r,  dull  eyes, 
expressionless  face,  pulse  slow  and  oppressed,  tendency  to  con- 
gestion, hemorrhages. 

Dose. — I^  Tinct.  Ergot  gtt.  v.,  water  Siv. ;  a  teaspoonful  every 
hour  to  three  hours. 

Homoeopathic  Indications,  (3d  to  6th  decimal). — Great  anxiety, 
fear  of  death.  Wild,  staring  look,  distortion  of  the  eyes,  vision 
obscured.  Sunken  countenance,  eyes  sunken.  Spasmodic  dis- 
tortion of  the  mouth  and  lips.  Female  complaints,  especially  in 
thin  individuals.  Vomiting  of  bile,  with  great  weakness.  Dry 
gangrene,  beginning  in  the  toes.  Very  debilitating  diarrhoea. 
Cholera. — Ehrmann. 

The  influence  of  Ergot  upon  the  system  is  very  similar  to 
Belladonna,  and  as  there  is  no  other  place  where  it  can  be  more 
properly  described,  we  will  place  it  here.  I  have  employed  it  in 
cases  where  there  was  an  oppressed  condition  of  the  nervous 
system,  with  a  tendency  to  coma,  a  labored  respiration,  and  full 
oppressed  pulse.  In  those  cases  in  which,  with  such  symptoms, 
there  are  convulsions,  it  will  be  found  particularly  useful.  I 
should  prefer  Belladonna  in  febrile  diseases;  Ergot  is  non-febrile. 

Iodide  op  Ammonium.  Specific  Indications. — Headache  with 
dizziness,  unsteadiness  of  walk,  feeble  or  sluggish  circulation. 

Dose. — Ijd  Iodide  of  Ammonium  grs.  x.  to  5ss.,  water  .5iv. ;  a 
teaspoonful  four  times  a  day. 

The  indications  for  this  remedy  are  occasionally  met  with  in 


36  DISEASES  OF   CHILDREN. 

diseases  of  children.  Sometimes  the  lesion  of  brain  is  purely 
functional,  but  at  others  it  will  be  found  strumous  or  syphilitic. 
In  the  latter  cases,  I  employ  this  and  the  iodide  of  potassium, 
where  the  tongue  is  broad  and  pallid  ;  Donovan's  solution  when 
it  is  small  and  red. 

Camphor.  Specific  Indications. — Pallid,  expressionless  face, 
pain,  sleeplessness,  with  tendency  to  exhaustive  discharges. 

Dose. — I|i  Tinct.  Camphor  gtt.  v.,  water  5iv.;  a  teaspoonful 
frequently  repeated. 

Homoeopathic  Indications,  {Sd  to  6th  decimal). — Coldness  of  the 
skin,  at  the  same  time  patient  does  not  wish  to  be  covered.  Sud- 
den prostration  with  diarrhoea.  Retention  of  urine,  with  con- 
stant pressure  on  the  bladder  and  desire  to  urinate.  Pulse  small, 
•weak,  and  slow. — Ehrmann. 

-Sther.  Specific  Indications. — Pain,  or  convulsive  action,  the 
face  being  pallid  and  cool,  and  circulation  feeble.  It  is  a  very 
good  remedy  for  the  relief  of  headache  from  an  enfeebled  circu- 
lation. 

Dose. — ^  ^ther  5j-,  simple  syrup  Sj-;  ten  drops  to  5ss.  may 
be  given  with  a  little  water.  As  an  aiisesthetic  it  may  be  em- 
ployed with  a  napkin  in  the  usual  way  of  administering  chlo- 
roform. 

With  the  indications  named  it  will  sometimes  promptly  relieve 
pain,  give  rest  and  sleep.  It  will  also  control  convulsions,  though 
the  dose  for  internal  administration^ is  usually  greater  than  that 
named.  It  is  also  sedative  at  least  to  the  extent  of  lessening  the 
frequency  of  the  circulation. 

It  is  now  regarded  as  a  safer  anaesthetic  than  chloroform,  and 
many  physicians  use  it  exclusively.  Some  employ  it  with  an 
equal  amount  of  chloroform,  its  action  being  quicker.  It  may  be 
used  by  inhalation  to  relieve  pain,  arrest  convulsive  action,  and 
prevent  its  recurrence,  as  well  as  for  complete  ansesthesia  when 
surgical  operations  are  to  be  performed.  A  spray  of  aether  is  used 
to  produce  local  anaesthesia,  in  minor  operations,  also  as  a  refrige- 
rant in  cases  of  inflammation. 

Chloroform.  Specific  Indications. —  Pain.  Convulsions. 
Gall  stones.     Surgical  operations. 

We  prefer  chloroform  as  an  anfesthetic  because  of  its  speedier 
action,  its  more  agreeable  effect  on  the  patient,  and  the  greater 


INFANTILE   THERAPEUTICS.  37 

ease  of  its  administration.  We  have  used  it  for  thirty  years, 
without  having  a  fatal  case,  and  think  that  with  care  it  is  one  of 
the  safest  remedies.  Who  can  say  as  much  for  any  of  the  agents 
in  common  use.  Say  Opium,  Aconite,  Veratrum,  Gelseminum. 
The  first  I  will  guarantee  has  killed  thousands,  where  one  has 
been  lost  by  chloroform. 

Chloroform  is  administered  as  an  anaesthetic  by  using  a  folded 
napkin  or  handkerchief,  cupping  it,  and  sprinkling  the  fluid  in 
the  cavity.  This  is  held  over  the  nose  in  such  manner  that  the 
vapor  may  be  inhaled  with  a  sufficient  quantity  of  air.  Especial 
attention  is  given  to  the  respiration,  which,  if  free,  assures  us 
that  the  patient  is  in  no  danger.  If  it  becomes  slow,  difficult,  or 
ceases,  the  inhalation  is  suspended,  the  child  is  turned  quickly, 
and  two  or  three  smart  blows  on  the  chest  or  buttocks  restores 
the  respiratory  function. 

We  use  chloroform  by  inhalation  to  relieve  intense  pain,  and 
to  arrest  convulsions.  Of  course  it  is  not  often  demanded  for 
the  first,  and  its  use  in  the  second  case  is  frequently  temporary — 
we  control  the  convulsions  for  the  time  being,  until  the  indicated 
remedy  can  be  given,  and  has  time  to  act.  This  is  much  better 
practice  than  to  allow  the  convulsive  action  to  continue  whilst 
we  are  vainly  striving  to  get  a  medicinal  action  through  the 
stomach. 

One  of  the  most  powerful  antispasmodics  at  our  command  is 
found  in  chloroform.  In  the  majority  of  cases  it  will  be  found 
safe  as  well  as  certain,  but  there  is  a  class  in  which  I  think  its 
use  dangerous.  There  are  cases  in  which  there  is  congestion  of 
the  brain,  and  especially  an  impairment  of  innervation  through 
the  sympathetic  nervous  system,  and  a  sluggish  general  circula- 
tion, with  tendency  to  congestion  of  all  important  organs.  It  is 
somewhat  difficult  to  diagnose  such  a  condition  ;  but  the  begin- 
ner will  do  well  to  reject  the  remedy  when  the  breathing  is 
labored,  the  pulse  not  much  increased  in  frequency,  when  the 
eyes  are  congested  and  the  lips  present  a  continued  dusky  or  pur- 
plish appearance. 

Chloroform  has  been  administered  in  very  large  doses  with 
safety,  though  I  do  not  think  they  should  be  recommended.  As 
much  as  a  teaspoonful  has  been  given  at  once  to  a  child  two 
years  of  age,  and  repeated.  A  half  teaspoonful  is  quite  fre- 
quently named  as  a  dose.  I  think  that  ten  drops  will  usually 
produce  the  effect  desired,  and  order  the  vehicle  in  such  propor- 


38  DISEASES  OF    CHILDREN. 

tion   as  to  give  this  quantity  in  a  teaspoonful.     Simple  syrup, 
glycerine,  or  mucilage,  are  good  vehicles  for  its  administration. 

Chloral  Hydrate.  Specific  Indications. — To  relieve  pain, 
promote  sleep,  arrest  convulsions,  and  relieve  the  cough  of  ner- 
vous irritation.  It  is  contra- indicated  when  the  circulation  is 
sluggish,  when  there  is  atendency  to  congestion,  pallid  bluish 
lips,  pale  leaden  tongue,  dull  eyes,  and  enfeebled  respiration. 

Dose. — The  dose  will  vary  from  one-half  to  five  grains,  for  a 
child  two  years  of  age,  and  it  may  be  given  with  syrup  and  water, 
as — ]^  Chloral  grs.  xx.,  simple  syrup  Sss.  water  .5iss. ;  dose  a 
teaspoonful. 

The  element  of  danger  in  the  administration  of  Chloral  must 
never  be  overlooked.  Adults  have  died  from  a  dose  of  but  ten 
grains,  whilst  as  much  as  three  hundred  grains  have  been  taken 
with  safety.  If,  however,  the  rule  given  above  is  observed,  I 
think  its  use  will  be  safe.  It  must  be  regarded  as  a  tern  pom  ry 
remedy  only,  and  when  the  present  emergency  is  passed  it  niiist 
be  suspended  for  permanent  remedies. 

Opium.  Specific  Indications. — The  pulse  is  small  and  open, 
waves  short,  the  face  pallid,  eyes  dull,  pain,  sleeplessness. 

Homoeopathic  Indications,  {^di  to  Qih  decimal). — Mania;  delir- 
ium tremens;  frightful  or  pleasing  visions,  alternating  with 
stupor;  steady  stertorous  breathing,  with  half  o])en  eyes;  bad 
effects  of  fright;  congestion  of  blood  to  the  brain,  with  strong 
pulsations;  staring  look,  glassy  immovable  eyes;  apoplexy  with 
deqi  snoring  breathing,  mouth  open  ;  paralysis  without  ])ain ; 
trembling  and  twitching  of  the  limbs;  constipation,  stools  in 
round,  black,  hard  balls ;  all  ailments  accompanied  by  sopor. — 
EJirmann. 

Opium  is  a  remedy  that  should  be  employed  with  very  great 
care  in  diseases  of  children,  though  it  need  not  be  discarded. 
There  are  some  cases,  in  which  a  judicious  use  of  opium  will 
calm  irritation  of  the  nervous  system  when  all  other  means  have 
foiled,  and  in  which  this  influence  is  essential  to  the  preservation 
of  life. 

The  danger  from  the  use  of  opium  is,  that  its  influence  on  the 
brain  be  such  as  to  im]>air  its  circulation  and  nutrition.  It  first 
stimulates  the  nerve  tisf^ue  and  increases  the  circulation  to  it ; 
and,  secondly,  exhausts  the  nerve  tissue  and  causes  congestion. 


INFANTILE  THERAPEUTICS.  39 

The  safest  use  of  opium  is  in  small  doses  to  obtain  its  stimulant 
action,  the  remedy  to  be  frequently  repeated  to  continue  the  in- 
fluence. Occasionally  a  case  occurs  in  which  the  little  patient  is 
very  much  exhausted,  and  suffers  pain  from  this  cause,  there 
being  neither  fever  nor  inflammation.  In  such  cases  opium  may 
be  used  with  advantage.  The  only  trouble  in  such  cases  as  it 
might  be  used  with  benefit  is,  that  it  tends  to  arrest  secretion, 
and  if  arrested  we  have  again  a  return  of  blood  poisoning. 

Occasionally  opium  is  giveu  in  the  form  of  some  soothing 
syrup,  cordial,  or  other  preparation  to  quiet  children,  until  we 
have  a  condition  of  chronic  poisoning.  The  symptoms  are  very 
marked — general  emaciation,  languor,  a  withered,  sallow  coun- 
tenance, red  and  swollen  eyelids,  derangement  of  the  digestive 
organs  with  loss  of  appetite,  and  constipation  of  the  bowels,  with 
white  stools. 

For  young  children  the  safest  preparation  is  the  compound 
poivder  of  ipecac  and  opium  of  our  Dispensatory.  I  generally 
add  five  grains  to  an  ounce  of  water,  sweeten  with  sugar,  and 
have  it  given  in  doses  of  half  a  teaspoonful  frequently,  until  the 
patient  is  relieved. 

Ammonium  Garb.  Specific  Indications. — The  pulse  is  feeble, 
circulation  to  the  surface  imperfect,  skin  pallid  or  dusky,  respira- 
tion difficult,  restless  and  sleepless. 

Homceopathic  Indications,  (3d  to  6th  decimal). — Suitable  for 
weak  and  nervous  persons  of  sedentary  habits.  Scarlet  fever 
when  the  rash  is  only  faintly  developed,  with  drowsiness,  stupor, 
dry  mouth,  right  parotid  gland  swollen,  burning  in  the  throat. 
— Ehrmann. 

Ammonia  is  an  excellent  diffusible  stimulant,  and  may  be 
employed  in  any  case  in  which  this  action  is  desirable.  The  ses- 
quicarbonate  of  ammonia  is  a  good  form,  and  may  be  given  in 
doses  of  one-half  to  three  grains,  in  sweetened  water.  It  is  espe- 
cially in  the  prostration  from  acute  disease  that  it  will  be  found 
serviceable. 

Phosphorus.  Specific  Indications. — In  acute  disease  there  is 
a  low  grade  of  inflammation,  with  feeble  cLi'culation,and  cerebral 
anemia;  urine  contains  mucus,  sometimes  pus, and  is  passed  with 
difficulty.  In  chronic  diseases,  an  enfeebled  nutrition  of  the 
brain,  imperfect  retrograde  metamorphosis  and  combustion,  with 
cacoplastic  or  tubercular  exudations. 


40  DISEASES   OF   CHILDEEX. 

Dose. — lu  acute  diseases — ^  Tiuct.  Phosphorus  gtt.  j.  to  gtt. 
v.,  water  §iv.;  a  teaspoouful  every  one  to  three  hours.  In  chronic 
disease  I  prefer  the  hypophosphites  :  hypophosphite  of  lime  gr.  ss. 
to  gr.  j.  three  times  a  day  ;  or  the  compound  syrup  of  the  hypo- 
phosphites,  one-fourth  to  one-half  teaspoonful  after  meals. 

Homceopathic  Indications,  (3d  to  6th  decimal). — Very  weak, 
empty  feeling  in  the  abdomen;  heat  up  the  back;  constipation, 
long,  hard,  and  dry  stools,  which  are  expelled  with  difficulty ; 
sour  eructations  and  sour  vomiting;  desire  for  cold  food  and 
drink,  which  is  vomited  as  soon  as  it  becomes  warm  in  the  stom- 
ach ;  vomiting  of  blood ;  watery  diarrhoea,  coming  away  in  a 
gush,  followed  by  a  sense  of  weakness  ;  sharp,  shooting  pains  in 
abdomen  ;  hoarseness,  loss  of  voice,  croup,  bronchitis ;  hard,  tight, 
dry  cough,  which  is  very  exhaustive,  worse  from  lying  on  the 
back  or  left  side;  expectoration  salty,  bloody  yellow,  purulent  or 
of  sour  taste;  more  expectoration  in  the  morning;  pneumonia, 
respiration  oppressed,  quick  and  anxious;  circumscribed  redness 
of  the  cheeks;  phthisis  pulmonalis,  particularly  in  tall,  slim  per- 
sons; pulse  rapid. — Ehrmann. 

Fekrooyanide  of  Potassium.  Specific  Indications. — In 
chronic  disease  there  is  marked  irritability  of  the  nervous  system, 
with  restlessness  and  broken  sleep;  the  pulse  and  respiration  have 
their  frequency  increased ;  mucous  membranes  are  pallid  and  lax 
with  increased  secretion,  bowels  irregular  and  tumid. 

Dose. — ^  Ferrocyanide  of  Potassium  5j-,  water  5Iv. ;  a  half 
teaspoonful  to  a  teaspoonful  three  or  four  times  a  day. 

This  remedy  may  be  used  in  catarrh,  chronic  pharyngitis, 
threatened  tuberculosis,  or  intestinal  diseases  simulating  tabes 
mesenterica.  Though  named  in  this  class  of  diseases — imperfect 
nutrition  with  tendency  to  aplastic  deposits — the  remedy  is  In- 
dicated by  the  peculiar  nervousness,  with  enfeebled  circulation 
and  nutrition  of  the  brain. 

(Enothera.  Specific  Indications. — ^A  sallow,  dirty  skin,  tis- 
sues full  and  expressionless,  dull  face  and  eyes,  large  sallow  tongue, 
feeble  innervation  with  broken  sleep  and  tendency  to  cry  on  the 
slightest  annoyance. 

Dose. — 1^  Tinct.  (Enothera  gtt.  x.,  water  Siv. ;  a  teaspoonful 
every  three  or  four  hours. 

Asafcetida. — This  is  one  of  the  oldest  antispasmodics  In  use, 
and  Is  a  vcrv  frood  roniedv  In  some  diseases  of  children.     Tl;e 


INFANTILE   THERAPEUTICS.  41 

objection  to  it  is  its  ofifensive  odor  and  taste,  which  render  it  diffi- 
cult of  administration.  Its  action  seems  particularly  beneficial 
when  the  spasmodic  or  convulsive  action  arises  from  an  irritation 
of  the  stomach,  or  parts  associated  with  it.  It  is  a  gentle  stimu- 
lant to  the  gastro-iutestinal  mucous  membrane,  and  relieves  irri- 
tation of  it.  The  tincture  of  asafoetida  with  simple  syrup  offers 
the  best  means  of  administration.  The  dose  of  the  tincture  will 
be  from  ten  to  twenty  drops. 

REMEDIES  WHICH   INFLUENCE  THE  CIRCULATION. 

Aconite,  Rhus,  Podophyllin, 

Veratrum,  Lycopus,  Hamamelis, 

Gelseminum,  Lobelia,  Cactus, 

Eupatorium,  Digitalis,  Apocynum  Canabinum, 

Spiritus  yEtheris  Nitrosi. 

Lesions  of  the  circulation  are  met  with  in  almost  all  forms  of 
disease,  and  in  many  are  a  principal  element,  so  that  if  the  cir- 
culation is  brought  to  a  normal  standard  and  kept  there,  the  dis- 
ease passes  away.  Readers  will  recall  the  teaching  that  there  is 
in  a  majority  of  cases  a  first  element  of  disease  (basic  element), 
upon  which  the  disease  is  based,  and  which  if  taken  away,  the 
other  wrongs  disappear  of  themselves.  This  is  frequently  the 
case  with  the  circulation.  Here  is  a  fever  or  an  inflammation 
with  a  pulse  of.  120  beats  per  minute,  small,  and  upon  this  as  a 
base,  we  have  a  temperature  of  104°,  arrested  secretion,  irritation 
of  the  nerve  centers,  and  symptoms  point  to  the  development  of 
a  typhoid  condition.  Aconite  is  given  in  the  usual  small  dose, 
and  as  the  pulse  comes  down  to  the  normal  standard,  the  tem- 
perature comes  down,  secretion  is  established,  the  nervous  irrita- 
tion and  pain  pass  away,  the  appetite  returns,  and  the  patient 
convalesces.  But  one  remedy  has  been  used,  yet  everything 
necessary  has  been  accomplished. 

The  association  between  frequency  of  pulse  and  temperature 
will  be  recalled,  for  every  ten  beats  of  pulse  an  increase  of  one 
degree  of  heat.  If  the  pulse  increases  in  frequency  the  tempera- 
ture increases,  as  the  pulse  comes  down  the  temperature  comes 
down.  With  a  high  temperature  every  process  of  life  is  im- 
paired, the  cause  of  disease  is  intensified,  and  molecular  death  is 
rapid.  As  the  temperature  comes  back  to  a  normal  standard  the 
various  functions  are  better  performed,  nutrition  commences, 
causes  of  disease  are  less  active,  and  the  body  frees  itself  from 
devitalized  material. 


42  DISEASES   OF   CHILDREN. 

Increased  frequency  of  pulse  intensifies  inflammatory  action, 
and  looks  toward  death  of  the  part.  In  inflammation  of  the 
respiratory  apparatus,  increased  frequency  of  pulse  causes  in- 
creased frequency  of  respiration,  cough,  determination  of  blood, 
pain  and  unrest.  We  control  the  inflammatory  process  as  we 
control  and  obtain  a  normal  circulation  of  blood. 

Aconite.  Specific  Indications. — The  pulse  is  small  and  fre- 
quent. (The  indication  is  short  but  explicit).  The  remedy  in- 
fluences special  parts,  as  the  throat,  the  larynx,  bronchial  tubes 
and  intestinal  mucous  membranes,  the  indication  being  irritation 
with  determination  of  blood. 

Dose. — ^  Tinct.  Aconite  gtt.  iij.  to  gtt.  v.,  water  5iv. ;  a  tea- 
spoonful  every  hour. 

Homceopathic  Indications,  (3d  to  6th  decimal). — Chill,  followed 
by  hot,  dry  skin,  quick,  full  pulse ;  great  restlessness  and  thirst, 
fear  and  anxiety  of  mind,  sudden  sinking  of  strength;  congestion 
to  head,  chest,  and  heart ;  anxious,  labored  breathing. — Ehrmann. 

The  pulse  is  small  and  frequent ;  it  seems  plain  enough  and  yet 
it  is  sufficient  for  all  our  purposes.  If  it  is  a  fever  the  tempera- 
ture will  be  increased  in  proportion  to  the  frequency  of  the 
pulse,  and  the  remedy  will  then  reduce  the  temperature  as  it 
brings  the  circulation  down  to  the  normal  standard.  If,  however, 
it  be  the  cold  stage  of  a  fever,  or  an  Asiatic  cholera,  it  will  in- 
crease the  warmth  of  the  body  as  it  gives  a  natural  circulation. 
The  frequent  small  pulse  is  the  indication  in  inflammatory  dis- 
ease when  there  is  marked  irritation  and  determination  of  blood, 
(an  active  condition),  but  the  remedy  serves  an  equally  good 
purpose  if  the  circulation  of  a  part  is  enfeebled — the  pulse  being 
small  and  frequent. 

Looking  at  the  action  of  remedies  in  the  usual  way,  this  seems 
very  strange — a  paradox — but  there  is  much  in  nature  that  we 
have  not  unraveled.  If  we  observe  the  action  of  Aconite  in 
fever,  we  find  that  as  the  pulse  diminishes  in  frequency  it  in- 
creases in  freedom,  and  there  is  a  better  circulation.  If  we  note 
its  action  in  cholera  we  observe  that  as  the  pulse  loses  its  fre- 
quency it  gains  volume  and  freedom,  and  there  is  a  better  circu- 
lation of  blood.  If  we  note  its  action  in  active  inflammation  we 
notice  that  it  lessens  determination  of  blood,  quiets  the  irritation, 
checks  the  rapid  circulation  in  the  capillaries  where  it  is  too 
active,  and  increases  the  circulation  where  it  is  sluggish.     If,  as 


INFANTILE   THERAPEUTICS.  43 

we  think,  it  acts  upon  and  through  the  ganglionic  system  of 
nerves,  we  can  account  for  all  of  this  by  saying  that  it  gives 
right  innervation.  I  have  been  in  the  habit  of  saying  that 
Aconite  was  a  stimulant  to  the  heart,  arteries  and  capillaries,  be- 
cause whilst  it  lessened  the  frequency  it  increased  the  power  of 
the  apparatus  engaged  in  the  circulation. 

In  noting  the  special  parts  and  tissues,  influenced  by  Aconite, 
we  may  commence  with  the  tonsils,  the  fauces  and  pharynx,  where 
its  influence  may  depend  somewhat  upon  its  topical  action  when 
swallowed.  It  has  a  direct  influence  upon  the  larynx,  and  is  one 
of  our  best  remedies  in  acute  laryngitis  and  croup;  indeed  I 
would  very  much  rather  trust  my  patients  with  Aconite  alone, 
than  with  all  the  old  materia  medica.  Its  influence  upon  the 
mucous  membrane  of  the  bronchia,  even  to  the  air  cells,  is  very 
marked. 

The  topical  action  of  Aconite  upon  the  stomach  relieves  irrita- 
tion, and  frequently  puts  this  organ  in  condition  to  receive 
remedies  and  food  kindly.  It  acts  directly  in  relieving  irritation 
of  the  intestinal  canal  from  stomach  to  rectum,  and  proves  one 
of  our  most  efficient  remedies  in  diarrhoea  and  dysentery,  as  well 
as  in  acute  diseases  of  the  associate  viscera. 

It  will  be  noted  that  Aconite  has  a  wide  range  of  use,  especially 
in  diseases  of  children.  It  may  be  called,  par  excellence,  the 
child's  remedy,  for  the  indication — small  and  frequent  pulse — is  a 
common  condition  in  the  acute  diseases  of  children.  I  can  almost 
agree  with  a  medical  friend  who  remarked,  that  if  he  had  only 
the  choice  between  Aconite,  and  the  remainder  of  the  materia 
medica,  in  diseases  of  childhood,  he  would  take  the  one  remedy. 

Veratrum.  Specific  Indications. — The  pulse  is  frequent  and 
full,  may  be  hard,  but  has  the  quality  of  strength.  The  circula- 
tion is  active,  the  skin  somewhat  flushed.  It  is  the  remedy  in 
inflammation  when  the  circulation  to  the  part,  and  in  the  part,  is 
active,  and  where  near  the  surface,  when  the  surface  is  flushed  red 
(the  color  of  arterial  blood). 

Dose. — ^  Tinct.  Veratrum  viride,  gtt.  v.  to  gtt.  x.,  water  Siv. ; 
a  teaspoonful  every  hour. 

Homoeopathic  Indications,  (3d  to  6th  decimal). — Great  arterial 
activity.  Convulsions  or  mania.  Meningitis,  cold  sweat  on  face, 
hmids  and  feet.  The  skin  looks  shriveled.  Opisthotonos. 
Ciiorea,  twitchings  and  contortions  of  the  body.  Froth  constantly 


44  DISEASES  OF    CHILDREN. 

on  the  lips.     Chewing  during  sleep.     Difficulty  in   swallowing. 
Neuralgia. — Ehrmann. 

The  use  of  Veratrum  is  clearly  indicated  above.  It  is  the 
remedy  for  stheuia,  when  the  heart  and  muscles  have  power,  and 
the  circulation  is  strong.  It  lessens  the  frequency  of  the  pulse, 
gives  a  free  and  equal  circulation,  lessens  the  temperature,  and 
thus  promotes  better  innervation  and  a  better  performance  of  all 
functions.  Thus  in  many  cases  it  will  do  all  that  is  necessary  to 
cure  a  fever. 

Its  action  upon  any  part  engaged  in  inflammation  is  of  the  same 
character,  whether  it  be  taken  internally  or  topically  applied.  It 
checks  determination  of  blood  by  relieving  irritation,  slows  the 
blood  in  the  capillaries  when  it  is  running  too  rapidly,  and  at  the 
same  time  it  gives  strength  to  the  enfeebled  tissues.  This  action 
may  be  witnessed  in  cutaneous  or  subcutaneous  inflammation,  or 
in  erysipelas  when  the  part  has  the  flush  of  arterial  blood.  It 
seems  to  make  but  little  difierence  where  the  inflammation  is 
located,  as  it  influences  the  entire  circulation. 

It  is  claimed  by  some  that  Veratrum  is  one  of  the  best  altera- 
tives in  our  Materia  Medica,  and  it  is  true  that  in  its  influence 
upon  the  ganglionic  nerves  and  the  circulation,  it  puts  the  excre- 
tory apparatus  in  the  best  condition  for  its  work,  and  favors  ret- 
rograde metamorphosis. 

It  does  not  depress  the  heart  or  the  patient  as  has  been  taught. 
In  medicinal  doses  it  increases  the  strength,  and  favors  normal 
functional  activity,  or  it  gives  a  better  circulation  of  blood.  Act- 
ing through  the  sympathetic  system  of  nerves,  it  not  only  gives 
a  slower  and  a  better  circulation  of  blood,  but  it  influences  every 
organ  and  part  supplied  by  this  system.  It  thus  improves  the 
condition  of  the  storaac*h  and  intestinal  canal,  favors  appetite, 
digestion  and  blood-making,  and  improves  secretion. 

Topically  applied  it  relieves  irritation,  checks  determination  of 
blood,  and-  arrests  the  inflammatory  process.  It  has  been  used 
with  the  best  results  in  this  way,  to  control  inflammatory  action. 
It  is  employed  as  a  local  remedy  in  erysipelas  when  the  inflam- 
matory action  is  active,  the  part  having  the  color  of  arterial 
blood. 

Gelsemixum. — A  study  of  Gelseminum  has  been  given  under 
the  head  of  "Remedies  which  Influence  the  Nervous  System." 
Its  influence  upon  the  circulation  is  very  direct,  when  tlie  fre- 
quent pulse  is  based  upon  an  excited  condition  of  the  nervous 


INFANTILE  THERAPEUTICS.  45 

system.  The  flushed  face,  bright  eyes,  contracted  pupils,  with  in- 
creased temperature,  are  the  indications,  but  with  this,  it  lessens 
the  frequency  of  the  pulse,  lowers  the  temperature,  controls  the 
inflammatory  process  and  favors  secretion  and  excretion. 

The  Gelseminum  case  (the  remedy  being  used  in  our  dose)  has 
a  vigorous  circulation,  the  pulse  being  frequent  and  free,  usually 
full,  the  capillary  circulation  also  being  free.  Locally  there  are 
evidences  of  determination  of  blood. 

EuPATORiUM  Perfoliatum.  Specific  Indications. — The  pulse 
is  full,  free  arid  strong,  the  surface  flushed,  temperature  increased, 
tendency  to  perspiration,  pain  in  the  loins,  fullness  of  chest  with 
sense  of  oppression,  sense  of  weight  with  pain  in  lumbar  region, 
frequent  desire  to  urinate,  urine  cloudy. 

Dose. — ^  Tinct.  Eupatorium  gtt.  x.,  water  5iv. ;  ateaspoonful 
every  hour. 

Homoeopathic  Indications,  (3d  to  6th  decimal). — Intermittent 
fever,  paroxysm  generally  commences  in  the  morning,  thirst  a  long 
time  before  the  chill,  after  the  chill  vomiting  of  bile,  pain  in  the 
bones,  as  if  broken,  before  the  chill.  The  fever  goes  off*  by  perspi- 
ration and  sleep.     During  the  apyrexia  loose  cough. — Ehrmann. 

Our  readers  will  recollect  the  old  use  of  "boneset"  following 
an  emetic  "  to  keep  the  fever  down,"  and  produce  diaphoresis,  or 
an  infusion  with  the  spirit  vapor  bath  "to  assist,"  or  in  the  early 
stage  of  a  malarial  fever,  when  the  patient  "  ached  in  every  bone," 
to  relieve  pain — boneset  it  was  called  and  bone-ache  it  relieved. 
Again,  in  rheumatic  fever,  when  the  patient  would  burn  one  hour 
and  sweat  the  next,  and  also  in  acute  rheumatism,  when  the  pain 
would  make  him  "  sweat  like  a  Turk,"  boneset  proved  a  good 
remedy. 

It  has  not  been  so  extensively  used  in  the  small  dose,  but  it  will 
be  found  valuable  in  many  cases  if  the  indications  are  observed. 
I  do  not  believe  in  substituting  it  for  a  better  remedy,  or  using  it 
when  Lobelia  or  Veratrum  would  serve  a  better  purpose,  but 
when  indicated  it  will  give  satisfaction. 

Rhus. — The  reader  will  find  a  study  of  Rhus  under  the  head 
of  "  Remedies  that  Influence  the  Nervous  System,"  and  we  only 
need  to  study  it  here  as  it  influences  the  circulation. 

With  a  frequent,  small,  sharp  pulse,  frontal  headache  (left  orbit), 
and  red  papillse  at  tip  of  tongue,  this  remedy  will  slow  the  pulse, 


46  DISEASES  OF  CHILDREN. 

lessen  the  temperature,  relieve  pain,  and  establish  secretion.  It 
is  true,  it  is  usually  administered  with  Aconite,  but  if  one  will 
give  it  alone  he  will  find  it  all-sufficient.  Burning  of  the  skin  is 
another  very  good  indication,  as  is  bright  eyes. 

Lycopus.  Specific  Indications. — The  circulation  is  active, 
pulse  frequent  and  hard,  determination  of  blood  to  a  part — lungs, 
stomach,  bowels,  kidneys — with  sanguineous  discharge  or  hemor- 
rhage, cough  with  sense  of  heat  or  burning  in  the  chest,  or  sense 
of  "  rawness,"  with  irritation. 

Dose. — ^  Tinct.  Lycopus  gtt.  v.  to  gtt.  x.,  water  Si  v. ;  a  tea- 
spoonful  every  one,  two  or  three  hours. 

This  remedy  is  not  in  common  use,  and  yet  will  be  found  of 
marked  value,  if  the  indications  as  above  are  followed.  We 
employ  it,  more  frequently,  in  diseases  of  the  chest  in  the  adult, 
and  especially  for  active  hemorrhage  and  an  irritative  cough.  In 
the  child,  it  will  be  especially  a  remedy  for  chronic  cough,  irrita- 
tion of  bronchial  tubes  and  lungs,  and  determination  of  blood  to 
the  kidneys. 

Lobelia. — The  full,  oppressed  pulse  is  the  indication  for  Lobe- 
lia as  a  sedative.  It  is  a  stimulant  to  the  circulation,  giving  power 
to  the  heart  and  arteries,  and  a  better  condition  of  capillaries  for 
the  blood  to  pass  through.  An  enfeebled  circulation  in  the  lungs 
with  a  sense  of  fullness  and  oppression  is  relieved  by  Lobelia. 

Digitalis.  Specific  Indications. — A  small,  frequent  pulse  with 
want  of  power  in  the  heart,  is  the  best  indication.  A  feeble  cir- 
culation in  lungs,  or  elsewhere,  with  scant  urine,  may  also  be  bene- 
fited by  this  remedy. 

Dose. — I^  Tinct.  Digitalis  gtt.  v.,  water  5iv. ;  a  teaspoonful 
every  one  or  two  hours. 

Homoeopathic  Indications,  (3d  to  6th  decimal). — Very  slow 
pulse;  harsh  appearance  of  the  face;  stools  gray  or  ash  color; 
urine  scanty;  pulsations  of  the  heart  intermit,  fainting;  ascites; 
hydrocele;  hydrothorax  ;  jaundice  with  light  colored  stools,  scanty 
brown  urine;  great  debility;  vertigo  with  trembling;  dimness  of 
vision,  dark  bodies  like  flies  hover  before  the  eyes. — Ehrmann. 

Digitalis  is  not  in  common  use,  and  has  not  been  studied  with 
the  care  given  to  others  of  this  class.  But  in  small  doses  it  will 
be  found  an  excellent  remedy.  Much  of  the  Digitalis  in  market 
is  of  poor  quality.     Of  a  recent  and  well  cured  specimen  of  the 


INFANTILE  THERAPEUTICS.  47 

lierb,  let  a  tincture  be  prepared  iu  the  proportion  of  four  ounces 
to  one  pint  of  alcohol  of  76  per  cent. 

The  principal  use  that  I  will  suggest  is,  as  a  stimulant  and 
tonic  to  the  heart  in  cases  of  anaemia  and  feeble  circulation.  In 
these  cases  it  is  associated  with  iron,  cod-liver  oil,  and  a  nutritious 
diet. 

Spiritus  ^theris  Nitrosi.  Specific  Indications. — The  pulse 
is  frequent  but  free,  the  skin  inclined  to  be  moist,  frequent  but 
scanty  passages  of  urine. 

Dose. — The  dose  will  vary  from,  gtt.  j.  to  gtt.  x.  Usually  we 
add  a  half  teaspoonful  to  a  half  glass  of  water,  and  give  it  in 
teaspoonful  doses  every  hour. 

It  is  a  little  difficult  for  one  who  has  been  thinking  of  medicine 
in  the  ordinary  way,  and  reading  regular  text-books,  to  think  of 
Sweet  Spirit  of  Nitre  as  a  sedative.  It  is  strong  alcohol  contain- 
ing a  portion  of  nitrous  ether,  and  may  be  regarded  as  an  alcohol, 
and  as  a  stimulant,  using  this  term  as  generally  understood.  But 
we  have  seen  that  the  remedies  classed  as  arterial  sedatives  are  in 
reality  stimulants,  that  is,  they  lower  the  frequency  of  the  pulse 
by  increasing  the  power  of  the  heart  and  arteries,  and  by  improv- 
ing the  condition  of  the  capillaries. 

The  practitioner  may  occasionally  use  the  Spirit  of  Nitre  with 
marked  benefit  in  simple  fevers  and  inflammations,  making  it 
take  the  place  of  Veratrum  or  Aconite. 

Cactus  Grandiflora. — The  pulse  is  irregular,  sometimes 
frequent,  occasionally  slow;  there  is  a  sighing  respiration,  sobbing, 
uneasy  dreams,  from  which  the  patient  wakes  crying  or  sobbing; 
face  is  pale,  eyes  expressionless;  pain  in  top  of  the  head  ;  sense  of 
oppression  in  region  of  the  heart. 

Dose. — I^  Tinct.  Cactus  gtt.  v.,  water  .^iv. ;  a  teaspoonful  every 
one  to  four  hours. 

HomcEopathic  Indications,  (3d  to  6th  decimal). — Heart  troubles, 
where  you  find  a  great  sense  of  constriction,  as  if  the  heart  was 
firmly  grasped  by  a  hand  or  in  a  vise ;  difficulty  of  breathing, 
attacks  of  suffocation  with  fainting,  cold  perspiration  and  loss  of 
pulse;  hemoptysis,  with  convulsive  cough;  chronic  bronchitis, 
with  rattling  of  mucus;  vomiting  of  blood,  hemorrhages  from 
nose,  lungs,  rectum,  or  stomach  ;  oedema  of  the  feet. — Ehrmann. 

The  indications  as  given  above  will  be  a  sufficient  guide  to  the 
use  of  the  remedy.  The  child  is  in  poor  health,  pale  and  inactive; 
very  sympathetic,  suffers  greatly  from  slight  unpleasantness;  sleeps 


48  DISEASES   OF  CHILDREN. 

in  the  day,  wakeful  and  fearful  at  night;  appetite  variable  ;  abdo- 
men full  or  doughy.  It  may  be  a  remittent  or  intermittent 
fever,  threatened  phthisis,  or  they  call  it  worms ;  we  give  Cactus 
and  the  patient  is  relieved. 

PoDOPHYLLiN.  One  would  hardly  think  of  Podophyllin  as  a 
remedy  influencing  the  circulation,  and  yet  it  does  so  in  a  very 
marked  manner.  The  veins  are  full,  face  full,  abdomen  tumid, 
tongue  full,  and  the  patient  complains  of  giddiness  and  unsteadi- 
ness, with  stupid  headache.  As  a  rule  the  pulse  is  full  and  op- 
pressed. I  have  used  it  with  most  marked  advantage  in  malarial 
fevers,  in  ague,  and  in  inflammatory  diseases,  and  hardly  know 
what  would  take  its  place.  The  reader  will  notice,  however,  that 
nothing  is  said  about  "  constipation  of  the  bowels,"  and  it 
makes  no  difference  to  us  whether  they  are  constipated  or  loose, 
if  the  indications  for  the  remedy  are  present.  It  will  also  be 
noticed  that  stress  is  placed  upon  "  fullness  of  tissue  ;"  when 
patients  are  pinched  we  never  give  it. 

I  use  a  first  or  second  centessimal  trituration  (one  to  one  hun- 
dred) in  diseases  of  children,  but  even  the  old  cathartic  dose  will 
prove  curative  when  the  symptoms  are  strongly  marked. 

Hamamelis.  Specific  Indications. — The  veins  are  full  and 
feeble,  varicose,  tissues  soft,  feeble,  relaxed,  swollen.  There  is 
fullness  about  the  anus,  prolapsus  ani,  difficult  evacuation  of 
feces,  swelling  of  vulva  or  prepuce,  oedema  of  legs,  spongy 
throat,  enlarged  tonsils,  abundant  mucous  discharge  from  nose, 
hemorrhage  from  atony. 

Dose. — The  distillate  of  Hamamelis  may  be  given  in  doses  of 
from  one  to  ten  drops,  or  in  the  usual  way.  ^  Hamamelis  gtt. 
X.,  water  .^iv. ;  a  teaspoonful  every  one  to  four  hours.  As  a 
local  application  it  may  be  used  of  full  strength,  or  diluted  with 
two  to  ten  parts  of  water. 

Homoeopathic  Indications^  (3d  to  6th  decimal). — Hemorrhoids, 
bleeding  profusely  with  sensation  of  soreness,  weight  and  burn- 
ing in  the  rectum ;  varices  protrude  and  the  anus  feels  sore  and 
raw;  stools  covered  with  mucus;  the  back  feels  like  breaking; 
restlessness  at  night ;  dryness  of  the  mouth  ;  varicose  veins, 
hard,  knotty,  swollen  and  painful.— E'Armann. 

Hamamelis  is  an  important  remedy,  and  when  the  physician 
learns  to  use  it  he  will  value  it  highly.  It  is  an  admirable  remedy 
in  acute  catarrh  when  secretion  is  establlslied  ;  in  chronic  oiitarrh, 


,    INFANTILE   THERAPEUTICS.  49 

chronic  pharyngitis  and  tonsillitis,  when  the  child's  voice  is 
husky  or  flat ;  in  chronic  bronchitis  with  free  secretion  ;  in  mucous 
diarrhoea,  abundant  urine  but  painful  micturition ;  in  hemor- 
rhoids, prohipsus  ani,  ottorrhoea,  sprains,  bruises,  atonic  inflam- 
mations, etc.  Remembering  that  it  strengthens  and  improves  the 
venous  circulation,  freeing  parts  from  congestion  and  giving  them 
tone,  we  can  hardly  go  astray  in  its  use. 

Apocynum  Canabinum.  Specific  Indications.  —  There  is 
oedema  of  feet,  eyelids,  or  of  an  inflamed  part.  The  pulse  may 
be  frequent  and  full,  or  frequent  and  feeble,  but  capillary  circu- 
lation is  weak. 

Dose. —  I|i  Tinct.  Apocynum  gtt.  v.,  water  5iv. ;  a  teaspoonful 
every  one  to  four  hours. 

Homoeopathic  Indications,  (3d  to  6th  decimal). — General  dropsy, 
hydrothorax,  urine  high  colored  and  scanty,  considerable  gastric 
disturbance,  pulse  weak  and  irregular,  skin  dry  and  husky,  hoarse 
loose  cough. — Erhmann. 

This  is  one  of  our  best  remedies,  and  the  indications  are  so 
clear  that  no  one  can  go  astray — oedema,  or  even  the  appearance 
which  a  tissue  presents  when  it  has  been  infiltrated  with  serum. 
In  this  as  with  other  remedies  it  does  not  make  any  difference 
what  name  the  disease  has,  if  the  indication  is  present.  We 
use  it  with  equal  advantage  in  cholera  infantum,  or  in  scarlet 
fever.  It  lessens  the  frequency  of  the  pulse,  gives  a  better  cir- 
culation of  blood,  stimulates  all  the  secretions  and  improves 
nutrition. 

If  I  notice  in  scarlet  fever  a  fullness  of  the  eyelids,  or  swelling 
of  the  feet,  I  give  Apocynum.  If  in  measles  there  is  difficulty 
in  breathing  with  a  harassing  cough,  and  the  face  or  feet  are 
puffy,  I  give  Apocynum.  So  I  would  in  croup  (inspiration  diffi- 
cult), in  infantile  remittent  fever,  in  inflammatory  diseases,  in 
rheumatism,  or  in  any  chronic  disease. 

REMEDIES    THAT   INFLUENCE   THE   TEMPERATURE. 

Baths,  Veratrum,  Acids, 

Food,  Rhus,  Alkalies, 

Air,  Gelseminum,  Cod  Oil, 

Exercise,  Bryonia,  Phosphorus, 

Aconite,  Baptisia,  Sulphur. 

Among  the  means  employed  in  the  treatment  and  cure  of  dis- 
ease, there  are  none  of   greater   importance   than  those  which 
4  , 


50  DISEASES  OF  CHILDREN. 

rectify  wrongs  of  temperature.  The  reader  will  recall  the  fact 
that  a  temperature  of  98°  is  essential  to  health,  and  the  perform- 
ance of  healthy  function.  Even  with  but  a  slight  variation  the 
person  is  ill,  and  the  illness  is  in  proportion  to  the  amount  of 
change.  If  the  temperature  falls  below  the  normal  standard, 
every  function  is  impaired — the  blood  is  not  circulated  well, 
respiration  is  feeble,  appetite  and  digestion  impaired,  nutrition 
bad,  and  waste  and  excretion  are  imperfect.  If  the  temperature 
is  increased  the  pulse  is  more  frequent,  the  nervous  system  ex- 
cited, (it  may  be  wrong  in  kind  or  oppressed),  the  appetite  lost, 
digestion  imperfect,  nutrition  arrested,  waste  and  excretion 
diminished,  and  changes  of  the  blood  go  on  more  rapidly. 

The  body  thermometer  is  one  of  our  most  certain  means  of 
diagnosis,  and  can  not  be  dispensed  with  by  any  one  who  wishes 
certainty  in  practice.  It  measures  the  intensity  of  diseased  ac- 
tion, and  determines  for  us  the  gravity  of  disease,  and  the  danger 
of  a  fatal  termination.  It  is  a  little  more  difficult  to  use  with 
children  than  with  adults,  but  there  is  hardly  a  case  that  the 
temperature  can  not  be  taken  at  the  axillae. 

In  studying  the  means  that  regulate  the  temperature  it  may  be 
well  to  recall  something  of  the  physiology  of  heat  production, 
and  the  means  that  nature  provides  to  maintain  this  constant 
temperature  of  98°.  The  heat  is  furnished  by  the  combustion  of 
food,  and  there  are  two,  possibly  three,  elements  here  to  be  taken 
note  of:  (a)  the  quality,  quantity  and  preparation  of  the  food  ; 
(6)  the  introduction  of  oxygen  by  respiration  for  combustion ; 
(c)  the  presence  in  the  blood  of  certain  materials  (phosphrus, 
sulphur,  etc.,)  which  may  be  regarded  as  excitants  of  combustion. 
If  a  sufficient  quantity  of  food  is. not  taken  the  body  is  burned  to 
supply  the  necessary  heat.  If  the  body  is  burned,  the  person 
suffers  the  excitation  of  burning. 

The  temperature  is  regulated,  in  so  far  as  the  production  of 
heat  by  combustion  is  concerned,  by  the  ganglionic  or  sympa- 
thetic system  of  nerves.  It  is  also  regulated  by  the  skin  which 
serves  as  a  safety-valve  for  the  body — opening  to  allow  the 
escape  of  heat,  when  it  is  produced  in  too  great  quantity,  and 
closing  to  retain  it,  when  produced  in  too  small  quantity.  Our 
remedies  influence  the  temperature  in  both  these  ways;  we  con- 
trol tlie  processes  of  combustion  through  remedies  influencing  the 
ganglionic  nerves,  influencing  the  circulation,  respiration  and 
combustion ;  we  influence  the  skin  so  as  to  put  it  in  better  condi- 


INFANTILE  THERAPEUTICS.  51 

tion  for  its  work,  increasing  secretion  and  respiration  for  the 
removal  of  heat,  stimulating  it  and  giving  it  lone  so  that  heat 
may  not  escape. 

Baths.'  The  importance  of  baths  in  the  treatment  of  disease 
has  been  clearly  shown  in  the  past  .fifty  years,  so  that  but  few 
will  dispute  their  advantage,  though  in  practice  they  may  not  use 
them.  I  think  that  the  success  of  our  school  of  medicine  has 
depended  as  much  upon  our  knowledge  of  bathing — the  water 
cure — as  upon  the  administration  of  drugs.  From  the  days  of 
Beach  we  have  been  using  cold  baths,  hot  baths,  alkaline  baths, 
acid  baths,  tonic  baths,  stimulant  baths,  vapor  baths,  general 
baths,  local  baths,  baths  to  reduce  the  temperature,  to  stimulate 
the  skin  and  increase  the  temperature,  to  promote  elimination,  to 
increase  the  respiratory  function,  etc. 

The  Cold  Wet-Sheet  Pack  is  not  used  as  frequently  as  it  might 
be  because  people  do  not  like  the  first  impression  of  cold,  and 
are  afraid  of  it.  In  young  children  the  nervous  excitement  from 
the  shock  is  sometimes  injurious,  but  if  well  borne,  and  there  is 
a  vigorous  circulation  with  increased  temperature,  its  action  is 
very  kindly. 

A  sheet  is  wrung  out  of  cold  water  and  spread  upon  the  bed, 
the  little  fellow  is  undressed,  lain  upon  and  wrapped  up  in  it. 
Blankets  and  comforts  are  spread  over  and  tucked  in,  and  in  a 
few  minutes  an  agreeable  warmth  takes  the  place  of  the  first 
impression  of  cold,  the  skin  is  moist,  the  pulse  comes  down, 
nervous  excitement  and  pain  pass  away,  and  presently  the  child 
sleeps  sweetly.  It  is  allowed  to  remain  in  the  pack  for  one  hour, 
when  the  body  is  rubbed  thoroughly  dry,  and  dry  clothing  is 
put  on. 

The  local  cold  pack  may  be  employed  in  acute  inflammation, 
with  an  active  circulation,  in  pharyngitis,  laryngitis,  croup,  in- 
flammation of  bronchia  or  lungs,  inflammation  of  bowels,  etc. 
A  towel  wrung  out  of  cold  water,  and  covered  with  dry  flannel, 
is  a  very  good  way  to  use  it. 

The  indication  is  an  increased  temperature  with  an  active  cir- 
culation. 

The  Hot  Wet-Sheet  or  Blanket  Pack  is  employed  when  the  skin 
is  enfeebled  and  inactive,  especially  in  the  eruptive  fevers,  and  in 
local  inflammations  when  the  circulation  is  feeble.  In  measles, 
scarlet  fever,  or  smallpox,  the  eruption  fails  to  make  its  appear- 


52  DISEASES  OF    CHILDREX. 

auce  at  the  proper  time,  the  nervous  system  is  oppressed,  there  is 
tendency  to  coma,  and  the  skin  shows  a  feeble  capillary  circula- 
tion. Here  a  hot  blanket  pack,  using  the  water  as  hot  as  it  can 
be  borne,  is  attended  by  the  best  results. 

The  local  hot  pack  is  used  in  acute  inflammations  when  the 
life  of  the  part  is  impaired  and  the  circulation  is  feeble.  We  thus 
use  it  in  sore  throat,  in  croup,  in  inflammations  of  the  respiratory 
apparatus,  in  diseases  of  the  abdominal  viscera,  local  inflamma- 
tions, etc. 

To  determine  whether  a  bath,  either  a  pack  or  hand-bath,  shall 
be  hot  or  cold,  is  important,  and  we  are  guided  by  this  :  If  the 
circulation  is  active  and  the  temperature  increased,  it  will  be  cold  ; 
but  if  the  circulation  is  feeble,  it  is  to  be  hot.  A  hemorrhage, 
or  an  abundant  discharge  of  mucus  or  pus,  or  an  increased  secre- 
tion, is  best  treated  with  the  hot  local  or  general  bath. 

Simply  Sponging  the  surface  with  water  lowers  the  temperature 
by  evaporation,  and  puts  the  skin  in  better  condition  to  perform 
its  function.  We  thus  use  it  several  times  in  the  day  when  per- 
sons are  suffering  with  fever  and  carrying  a  high  temperature. 
When  necessary  soap  is  used  for  the  purpose  of  cleanliness. 

The  Alkaline  Sponge  Bath  is  one  of  the  old  Eclectic  means,  and 
a  very  important  one.  Originally  it  was  broke  water,  wood  ashes 
being  used  in  sufficient  quantity  to  make  the  water  slightly  slip- 
pery to  the  touch ;  after  this  pearlash  or  bicarbonate  of  potash 
was  used  in  place  of  the  ashes.  In  more  modern  days  soda  has 
taken  the  place  of  potash,  and  now  the  alkaline  bath  is  a  soda 
bath.  The  "  broke  water "  or  potash  was  decidedly  the  best  in 
the  majority  of  cases,  its  action  upon  the  skin  being  kindlier, 
leaving  it  in  better  condition.  When  I  speak  of  the  alkaline 
bath,  I  wish  to  be  understood  as  recommending  water  made 
alkaline  with  potash. 

If  one  is  in  doubt  whether  the  sponge  bath  should  be  alkaline 
or  acid,  he  will  do  well  to  note  the  indications  as  presented  by 
the  tongue.  If  the  tongue  is  broad  and  pallid  the  bath  should  be 
alkaline;  if  red,  especially  if  deep  red,  it  should  be  acid. 

The  Acid  Bath  (water  acidulated  with  vinegar)  will  be  found  to 
exert  a  very  pleasant  influence  upon  the  skin,  w^lien  indicated, 
leaving  it  soft  and  in  better  condition  to  do  its  work.  The  alka- 
line bath  may  have  been  used,  leaving  the  skin  dryer  and  harsher 
than  it  was  before,  whilst  the  acid  batli  gives  relief.  The  child's 
face  and  head  are  hot  and  dry,  and  the  ordinary  use  of  water  does  no 


INFANTILE   THERAPEUTICS.  53 

good )  it  is  sponged  with  vinegar  and  water  and  is  relieved,  and 
presently  sleeps. 

In  some  rare  cases  we  use  water  acidulated  with  muriatic  acid; 
in  a  larger  number,  especially  where  the  symptoms  are  typhoid, 
and  it  is  almost  impossible  to  keep  the  child  free  from  unpleasant 
odors,  we  use  sulphurous  acid. 

Fatty  Inunction  is  a  most  important  means  of  putting  the  skin 
in  better  condition  and  rectifying  the  wrongs  of  temperature. 
Sometimes  we  use  lard  alone,  the  child  being  thoroughly  rubbed 
with  it,  and  then  rubbed  clean  with  soft  flannel.  In  some  cases  we 
add  quinine  to  lard,  5ss.  to  5j.  to  .^ij.,  especially  when  there  is  a 
malarial  influence,  or  when  we  wish  to  stimulate  the  brain  or 
spinal  cord.  In  other  cases  when  stimulation  is  wanted,  oil  of 
cinnamon,  cloves,  or  eucalyptol,  is  added. 

In  scarlet  fever  we  sometimes  use  a  "bacon  rind,"  or  a  pre- 
scription of  creasote  and  salt  with  lard,  as  a  stimulant  to  the  con- 
gested skin.  It  lowers  the  temperature,  improves  the  circulation, 
gives  better  functional  activity,  and  favors  the  appearance  of  the 
eruption. 

In  malarial  or  typho-malarial  fevers  I  have  seen  the  inunction 
of  quinine  lower  the  temperature  two  degrees  in  as  many  hours, 
lessen  the  frequency  of  the  pulse,  and  in  a  short  time  arrest  the 
disease,  when  quinine  internally  had  not  only  failed  to  do  good,  but 
had  proven  harmful.  In  cholera  infantum,  especially  if  attended 
by  fever,  the  quinine  inunction  is  one  of  our  most  important 
remedies. 

We  use  inunction  In  chronic  disease  when  innervation  is  fee- 
ble, the  appetite  and  digestion  poor,  nutrition  imperfect,  and  skin 
atonic.  In  some  cases  it  exerts  a  very  salutary  influence,  and 
patients  improve  from  the  commencement  of  the  rubbing. 

The  Stimulant  Bath  is  occasionally  useful  when  the  circulation 
is  feeble.  It  may  be  a  mustard-water  pack,  when  there  is  sudden 
and  great  prostration  ;  quinine  with  proof- spirit  when  there  is  a 
malarial  influence  ;  or  an  infusion  of  Xanthoxylum,  Polygonum, 
or  remedies  of  like  character. 

To7i{o  or  Astringent  Baths  are  employed  in  some  cases  where 
the  skin  is  atonic  and  the  circulation  is  feeble.  An  infusion  of 
Hydrastis  may  represent  the  first,  and  of  Quercus  rubra  the 
second. 


54  DISEASES   OF   CHILDREN. 

Food. — It  might  be  thought  that  a  study  of  foods  would  come 
more  appropriately  elsewhere,  and  we  will  have  occasion  to  notice 
them  again  under  tlie  heading,  Restoratives.  But  heat  is  set 
free  by  the  oxygenation  of  food,  or  of  tissue,  its  only  sources,  so 
far  as  we  know.  Foods  are  calorifacient  or  heat-producing,  and 
histogenetic  or  tissue-making.  The  first  contains  no  nitrogen, 
the  second  contains  nitrogen.  The  first  may  be  represented  by 
sugar  and  starch ;  the  second  by  the  albumen  and  gluten  of  vege- 
table substances,  and  the  albuminoid  and  muscular  tissues  of 
animals. 

The  majority  of  foods  are  in  part  calorifacient  and  in  part  his- 
togenetic, and  we  determine  their  value  in  tissue-building  by  the 
per  centage  of  nitrogen  in  them.  When  this  is  low,  the  food  is 
principally  heat-producing,  where  it  is  large  the  food  is  eminently 
tissue-making.  For  the  child,  milk  contains  these  elements  in 
the  best  proportion,  though  we  use  a  starchy  food,  or  fat,  when 
heat  is  especially  wanted,  or  beef  tea  when  a  stimulant,  tissue- 
making  food  is  wanted. 

If  a  child  is  carrying  a  high  temperature  in  fever  and  inflam- 
mation, and  is  taking  no  food,  the  body  is  burned  to  supply  the 
heat.  The  body  can  not  be  burned,  even  slowly,  without  irrita- 
tion of  the  nervous  system  and  suffering.  I  am  sure  that  this 
will  account,  many  times,  for  the  restlessness,  sleeplessness,  and 
final  wearing  out  of  the  nervous  system  in  febrile  and  inflamma- 
tory disease. 

One  of  the  maxims  of  a  rational  practice  of  medicine  is — to 
keep  the  stomach  in  such  reasonably  good  condition  that  a  por- 
tion of  food  may  be  taken  and  digested,  and  we  look  as  carefully 
after  the  food  of  the  sick  as  their  medicine. 

In  many  cases  we  find  that  if  we  relieve  a  temporary  irritation 
or  atony  of  the  stomach,  so  that  the  child  can  take  a  moderate 
amount  of  milk  or  other  food,  the  temperature  comes  down,  and 
the  irritation  of  the  nerve  centers  passes  away,  and  the  chUd  rests 
and  sleeps.  By  giving  food  we  supply  the  materials  for  combus- 
tion, and  save  the  tissues  of  the  body. 

In  some  cases  of  chronic  disease,  we  will  observe  a  deficient 
temperature,  or  the  heat  is  not  properly  distributed,  the  feet  and 
hands  being  cold.  In  such  cases  a  supply  of  such  calorifacient 
food  as  may  be  digested,  not  only  furnishes  the  98°  of  heat  which 
is  an  essential  condition  of  life,  but  such  other  force  as  may  aid 
nutrition  and  give  the  force  necessary  for  exercise. 


INFANTILE  THERAPEUTICS.  55 

Air.  Air  is  usually  studied  as  a  condition  of  healthy  life,  and 
as  a  cause  of  disease,  but  if  a  condition  of  life,  then  it  must  prove 
a  remedy  in  some  cases  of  disease.  A  certain  amount  of  air  taken 
through  the  respiratory  apparatus  is  necessary  for  combustion  and 
heat  production,  and  if  patients  are  not  supplied  with  it  they  must 
suffer.  We  place  stress  on  the  necessity  for  good  ventilation — a 
sufficiently  free  admission  of  air  to  the  apartment,  and  a  current 
of  air  from  it,  usually  by  means  of  an  open  fire. 

The  open  air  is  necessary  for  a  cure  in  some  cases  of  chronic 
disease  in  children,  as  it  is  for  the  adult.  If  the  little  patients 
can  have  that  moderate  exercise  which  calls  into  action  the  respi- 
ratory apparatus,  it  is  so  much  the  better. 

A  dry  air,  from  stove  heat,  is  sometimes  so  irritant  that  it  ex- 
cites the  nervous  system,  increases  the  frequency  of  the  pulse,  and 
will  increase  the  temperature.  A  very  moist  atmosphere  may  be 
so  depressing  that  the  functions  of  life  are  feebly  performed,  and 
we  will  be  obliged  to  rectify  this  if  we  cure  the  patient.  Again, 
the  air  may  be  so  loaded  with  dirt,  or  unpleasant  gases,  that  it 
will  not  sustain  life,  and  in  severe  cases  is  absolutely  poisonous. 
A  cure  comes  in  such  cases  from  free  ventilation,  cleanliness,  and 
the  use  of  agents  which  change  or  destroy  the  unpleasant  mate- 
rial, as  chloride  of  lime,  chlorinated  soda,  sulphurous  acid,  etc. 

Exercise.  As  we  have  just  seen,  where  the  respiratory  move- 
ment is  feeble,  the  processes  of  combustion  go  on  slowly  and  a 
sufficient  amount  of  heat  is  not  produced.  In  addition  to  this, 
the  burning  of  waste  material  and  old  tissues  is  not  properly  per- 
formed, and  the  body  and  blood  are  loaded  with  effete  material. 
We  find  some  chronic  diseases  of  children  where  the  exercise  that 
a  child  will  get,  if  a  rug  is  thrown  upon  the  floor  and  it  is  allowed 
to  tumble  around  upon  it,  is  better  than  medicine. 

In  the  neighborhood  of  the  sea,  children  are  sent  to  the  sea- 
shore and  allowed  to  roll  on  and  dig  in  the  sand.  In  cities  nurses 
take  children  to  the  parks  and  allow  them  to  make  sand  and 
gravel  houses  or  fortifications  of  the  gravel  walks.  What  we 
want  to  know  in  these  cases  is,  that  every  effort  should  be  made 
to  induce  the  child  to  play  and  amuse  itself,  and  thus  get  the  ne- 
cessary exercise,  and  that  nursing  in  the  arms  is  the  worst  possible 
way  to  obtain  good  health. 

But  the  knowledge  of  when  rest  is  necessary  is  just  as  essential. 
Rest  to  body,  rest  to  nervous  system  and  sleep,  are  essential  in 
the  treatment  of  diseases  which  have  a  high  temperature.  Restless- 


56  DISEASES   OF  CHILDREN. 

ness  and  want  of  sleep  are  almost  certain  to  increase  the  tempera- 
ture; even  the  continuous  fretting  of  a  sick  child  for  something 
it  wants,  or  for  its  mother,  will  send  the  thermometer  up  one  or 
two  degrees. 

A  part  suffering  from  inflammation  needs  rest,  sometimes  the 
absolute  rest  that  we  get  by  the  use  of  a  splint.  We  arrest  the 
progress  of  a  morbus  coxarius,  or  a  disease  of  the  knee  joint  by 
a  plaster  of  Paris  or  other  dressing  which  will  give  absolute  rest. 
A  flaunej  bandage  so  nicely  adjusted  that  it  will  support  the 
abdomen  well,  is  sometimes  one  of  our  best  prescriptions  for 
cholera  infantum. 

Aconite.  This  remedy  has  been  twice  studied,  but  it  will  do 
no  harm  to  look  at  it  as  a  remedy  influencing  the  temperature. 
We  have  already  noted  the  relation  between  the  pulse  and  the 
temperature,  an  increase  of  one  degree  of  heat  for  each  ten  beats 
of  pulse.  If  the  pulse  is  lessened  in  frequency  by  remedies  the 
temperature  comes  down,  and  vice  versa.  All  arterial  sedatives 
are  therefore  thought  to  lessen  the  temperature,  when  above  the 
normal  standard,  and  this  is  especially  true  of  Aconite  and 
Veratrum. 

But  this  remedy  influences  the  functions  of  calorification  di- 
rectly through  the  ganglionic  and  respiratory  nerves.  We  have 
been  in  the  habit  of  thinking  that  it  always  lessens  heat  pro- 
duction, and  it  very  certainly  does  so  in  many  cases  when  the 
temperature  is  too  high.  But  if  one  will  administer  the  remedy 
in  a  case  of  congestive  chill  or  cholera,  when  the  pulse  is  small 
and  running  over  one  hundred  beats  per  minute,  he  will  see  it 
increase  the  temperature,  and  parts  that  were  cold  regain  their 
heat. 

Yeratrum.  This,  like  the  preceding  remedy,  has  a  direct 
influence  upon  the  function  of  calorification,  both  as  it  influences 
the  circulation,  respiration  and  combustion.  All  these  are  too 
active  and  characterized  by  strength,  and  Veratrum  lessens  the 
excitement  and  the  activity.  When  indicated  it  will  frequently 
lower  the  temperature  from  one  to  three  degrees  in  twelve  hours, 
and  in  minor  diseases,  like  the  febricula,  or  at  the  commencement 
of  inflammations,  it  may  bring  it  down  to  the  normal  standard  in 
a  very  short  time. 

Its  influence  i"n  superficial  inflammation,  when  topically  ap- 
plied, is  sometimes  so  marked  as  to  excite  surprise.     The  irrita- 


INFANTILE  THERAPEUTICS.  67 

tion  is  relieved,  determination  of  blood  is  arrested,  and  the  tem- 
perature falls  in  a  short  time. 

Rhus.  We  have  studied  Rhus  as  a  remedy  influencing  the 
nervous  system,  but  its  influence  in  controlling  the  temperature  is 
not  to  be  neglected.  It  allays  irritation  of  the  nerve  centers, 
especially  of  the  ganglionic  system,  and  slows  the  process  of 
combustion.  In  the  larger  number  of  cases,  when  indicated,  it 
markedly  reduces  the  temperature ;  indeed  its  action  in  this  direc- 
tion is  quite  as  marked  as  any  remedy  of  the  materia  medica. 

Bryonia.  This  is  another  remedy  that  lessens  the  function 
of  calorification,  (when  the  temperature  is  high,)  by  relieving 
irritation  of  the  ganglionic  nerves,  and  possibly  by  its  action 
upon  the  blood.  It  will  be  remembered  that  pain  is  one  of  the 
principal  indications  for  Bryonia,  and  pain  is  the  evidence  of 
unrest. 

Gelseminum.  Gelseminum  lessens  the  temperature  by  allay- 
ing cerebro-spinal  irritation  which  is  back  of  ganglionic  excite- 
ment. When  indicated  by  flushed  face,  bright  eyes  and  contracted 
pupils,  its  influence  is  very  marked  in  this  direction. 

Baptisia.  This  remedy  is  fully  studied  under  the  head  of 
Antiseptics,  but  it  also  exerts  a  marked  influence  in  lowering  the 
temperature  when  above  the  normal  standard.  Like  other  remedies 
it  requires  the  special  indications — the  full  purplish  face,  like  one 
who  has  been  exposed  to  severe  cold,  and  a  bluish-red  tongue. 
In  this  case  the  high  temperature  is  dependent,  in  part,  upon  a 
peculiar  sepsis,  and  this  being  antidoted  the  temperature  falls 
rapidly.  I  have  seen  it  come  down,  under  the  influence  of  Bap- 
tisia alone,  from  106°  to  100°  in  twenty-four  hours. 

Acids.  Specific  Indications. — The  tongue  is  dusky  red  or  deep 
red,  and  frequently  small ;  mucous  membranes  and  sometimes  the 
skin  show  the  same  color.  The  coatings  of  tongue  and  sordes 
upon  the  teeth  brown,  growing  darker  as   the  disease  progresses. 

Dose. — Usually  we  order  muriatic  acid  5i-,  water,  syrup,  aa. 
•51. ;  add  to  water  so  as  to  make  it  pleasantly  acid,  and  give  as 
patient  will  take  it.  In  some  cases  a  sharp  sparkling  cider  is 
used  and  given  a  teaspoonful  to  a  tablespoonful  in  water  every 
three  or  four  hours.  In  other  eases  an  acid  whey  (lactic  acid) 
will  be  taken  by  the  patient,  whilst  the  others  will  be  rejected. 

The  truth  of  specific  medication  is  well  illustrated  by  the 
action  of  acids  and  alkaline  agents  in  the  cure  of  disease.     That 


58  DISEASES   OF    CHILDREN. 

they  are  curatives  no  one  will  dispute ;  that  they  act  equally  well 
in  the  same  cases,  or  that  they  can  be  taken  by  chance  and  get 
uniform  good  results,  no  one  will  claim.  If  they  are  to  be  used 
at  all  we  must  have  some  means  of  determining  when  we  shall 
use  the  one,  and  when  the  other.  I  determine  this  by  the 
color  of  tongue,  and  where  blood  shows  freely  as  in  mucous  mem- 
branes and  some  portions  of  the  surface.  If  the  color  is  deep 
or  dusky  red,  an  acid  is  wanted ;  if  it  is  pale,  pallid,  the  patient 
requires  an  alkaline  salt;  if  neither  the  patient  requires  neither 
the  one  nor  the  other.  If  any  one  has  a  better  means  of  deter- 
mining these  points,  then  the  better  light  should  be  followed ;  if 
not  we  will  continue  to  be  guided  by  the  color. 

When  indicated  the  acid  exerts  a  marked  influence  in  lessening^ 
an  exalted  temperature,  and  will  sometimes  reduce  it  when  seda- 
tives and  baths  have  wholly  failed.  This  is  especially  true  when 
typhoid  symptoms  are  present,  as  the  acid  antidotes  the  process 
of  sepsis.  Thus  in  England  and  on  the  Continent,  the  continued 
fevers  have  been  treated  with  acids  alone,  (diet,  rest  and  good 
nursing  added,)  in  thousands  of  cases  with  most  marked  success, 
the  mortality  being  reduced  in  some  cases  to  two  or  even  one 
per  cent.  If  we  can  give  our  little  patients  a  pleasant  acid  drink 
in  place  of  the  nauseous  drugging  of  the  olden  time  we  should  be 
thankful. 

Not  only  is  the  acid  of  advantage  when  given  internally,  but 
the  acidulated  bath  is  a  means  not  to  be  neglected.  There  are 
cases  when  the  ordinary  bath  or  the  alkaline  bath  seems  to  make 
no  impression  upon  the  skin  or  the  temperature,  but  when  a  little 
vinegar  added  to  water  is  refreshing  and  cooling,  the  hot  face  and 
head  sponged  with  vinegar  and  water  have  given  relief,  the  irrita- 
tion is  quieted  and  the  patient  sleeps.  The  tense,  hot  abdomen, 
with  skin  like  parchment,  is  softened,  cooled  and  relieved  of 
irritation  by  an  acid  bath  or  pack.  It  will  not  do  to  neglect  the 
"  small  things  "  in  the  practice  of  medicine. 

Alkaline  Salts.  Specific  Indications. — The  tongue  is  broad 
and  pallid;  and  its  coatings  are  white  and  pasty. 

Dose. — If  there  is  no  special  indication  for  another,  we  will 
employ  a  salt  of  soda,  for  soda  is  the  salt  of  the  blood.  "We  add 
it,  usually  the  bicarbonate,  to  water  in  such  quantity  as  will  make 
a  pleasant  drink,  and  let  the  patient  take  it  freely. 

If  there  is  marked  muscular  debility  we  use  a  salt  of  potash  in 
place  of  the  soda. 


INFANTILE   THERAPEUTICS.  59 

If  there  is  a  tendency  to  subcutaneous  inflammation,  or  inflam- 
mation and  suppuration  of  cellular  tissue,  lime-water  or  sulphite 
of  lime  is  to  be  given. 

The  indications  for  the  use  of  the  alkaline  salts  are  so  clear  that 
no  one  can  mistake  them.  Why  they  should  lessen  the  temper- 
ature (when  in  excess)  as  do  the  acids,  is  more  than  we  can  say 
with  our  present  knowledge ;  only  this,  that  they  correct  a  wrong 
of  the  blood  and  the  fluids  of  the  body,  and  r.ighting  this  wrong, 
they  remove  the  nervous  and  vascular  excitement  which  was 
caused  by  it. 

The  one  thing  in  therapeutics  that  we  can  not  have  impressed 
upon  us  too  forcibly  is,  that  the  prominent  lesion,  as  indicated  by 
those  symptoms  that  point  us  to  remedies,  is  very  frequently  the 
basis  of  the  disease,  and  if  taken  away  the  entirety  of  the  disease 
passes  away  of  itself. 

In  our  Western  country,  and  where  malarial  diseases  prevail, 
the  alkalies  are  much  more  frequently  indicated  than  the  acids ; 
indeed,  in  some  seasons  diseases  are  cured  by  these  alone.  I  re- 
call a  year  of  malarial  fever  in  which  sulphite  of  soda  or  chloride 
of  sodium  was  more  certain  than  quinine;  indeed  they  would  cure 
ague  when  quinine  had  failed.  In  rheumatic  fever  this  is  also 
the  case  in  some  seasons,  and  the  indications  for  the  alkaline  salts 
being  marked,  they  cure  rheumatism. 

Phosphorus.  Specific  Indications. — Phosphorus  is  indicated 
by  a  low  temperature,  cold  extremities,  doughy  or  waxy  skin, 
enfeebled  nutrition  of  the  nerve  centres  with  want  of  innervation, 
sensation  of  weight  and  pressure  in  peritoneum  and  pelvis,  irri- 
tation of  urinary  passages  and  burning  on  passing  urine. 

Dose. — The  tincture  of  phosphorus  is  used  in  low  grades  of 
inflammation  of  the  respiratory  apparatus,  in  disease  of  the  pros- 
tate, bladder  and  urethra;  the  hypophosphites  to  improve  waste 
and  excretion,  and  to  aid  blood-making  and  nutrition.  The 
phosphites  are  used  to  aid  digestion  (laxative)  and  to  favor  nutri- 
tion.— I^  Tinct.  Phosphorus  gtt.  v.  to  gtt.  x.,  water  Siv. ;  a  tea- 
spoonful  every  one  to  four  hours.  Hypophosphite  of  lime  gr.  \ 
to  gr.  j.,  every  four  hours.  Phosphate  of  soda  gr.  j.  to  grs.  ij., 
twice  or  three  times  a  day. 

It  will  be  noticed  from  what  has  been  said  above,  that  phos- 
phorus has  an  extended  use  in  medicine,  but  it  must  be  employed 
with  care.      I  employ  the  tincture  in  diseases  of  children  but 


60  DISEASES  OF    CHILDREN. 

rarely,  selecting  those  cases  where  there  is  an  atonic  condition  of 
the  respiratory  apparatus,  or  where  there  is  disease  of  the  bladder 
and  urethra. 

To  stimulate  calorification,  and  increase  the  production  of  heat, 
and  also  to  burn  waste  material,  I  prefer  the  hypophosphites. 
The  hypophosphite  of  lime  is  preferred  where  there  is  tendency 
to  deposit  of  tubercle  or  disease  of  cellular  tissue;  the  hypophos- 
phite of  soda  when  the  tongue  is  broad  and  pallid,  and  a  salt  of 
soda  would  be  given.  The  compound  syrup  of  the  hypophosphites 
is  sometimes  useful  both  to  increase  calorification  and  to  aid  nu- 
trition. 

Cod  Liver  Oil.  Specific  Indications. — The  extremities  are 
cool ;  the  skin  relaxed,  doughy  or  dirty ;  tongue  dirty  at  base ; 
bowels  irre'gular ;  pulse  lacks  strength  ;  small  boils  ;  inflammation 
of  cellular  tissue ;  ulceration  of  the  skin ;  bad  blood. 

Dose. — The  dose  of  cod  oil  for  a  child  will  vary  from  one-half 
to  two  teaspoonfuls  three  times  a  day.  A  pure  inodorous  oil  will 
frequently  be  taken  without  difficulty. 

The  indications  given  above  will  point  out  the  cases  which 
will  be  benefited  by  cod  oil.  The  processes  of  combustion  do  not 
go  on  well,  the  waste  of  tissue  is  not  burned  as  it  should  be,  and 
fitted  for  excretion,  and  the  blood  is  loaded  with  it.  This  impairs 
the  new  blood  that  is  making,  the  new  tissues  which  are  building, 
and  enfeebles  all  the  functions  of  the  body.  In  this  way  the  pa- 
tient grows  the  conditions  which  give  cacoplastic  and  aplastic 
deposits. 

In  some  cases  all  the  functions  seem  to  be  stimulated  by  the 
administration  of  the  oil.  The  skin  becomes  clean  and  active,  the 
appetite  improves  and  digestion  is  better,  and  there  is  an  increase 
of  tissue. 

Quinine.  We  have  already  made  a  full  study  of  quinine  un- 
der the  head  of  Remedies  which  Influence  the  Nervous  System, 
and  we  will  only  consider  it  here  as  it  influences  the  temperature. 
It  was  shown  by  Prof  I.  G.  Jones,  that  in  the  purely  malarial 
fevers — uncomplicated — this  remedy  could  be  administered  with 
the  effect  of  lowering  the  temperature,  diminishing  the  frequency 
of  the  pulse,  and  establishing  a  complete  intermission  of  the 
fever,  if  not  arresting  it.  In  the  remittent  fevers  of  the  Scioto 
valley  the  administration  of  quinine  would  commence  as  soon  as 
the  highest  point  of  fever  was  passed,  and  then  repeated  every 
three  hours,  there  would  be  a  marked  abatement  of  the  disease. 


INFANTILE  THERAPEUTICS.  61 

In  diseases  of  children  in  malarial  regions,  the  action  of  qui- 
nine is  frequently  desirable.  The  temperature  is  high,  the  pulse 
frequent,  the  secretions  checked,  and  we  are  sure  of  the  periodic 
character  of  the  disease — the  proper  quantity  of  the  remedy  as 
an  antiperiodic  is  given  in  divided  doses,  and  the  fever  is  arrested. 

In  the  very  minute  dose,  or  when  used  by  inunction,  it  will 
sometimes  exert  a  very  marked  influence  in  controlling  the  tem- 
perature, even  when  the  disease  is  not  malarial.  We  do  not  wish 
to  recommend  it,  however,  when  other  remedies  are  indicated,  for 
it  is  used  far  too  frequently  now,  and  to  the  injury  of  many  pa- 
tients. 

Nux  Vomica.  This  remedy  has  been  fully  studied  elsewhere, 
and  we  have  only  to  notice  it  here  as  a  stimulant  to  the  respira- 
tory system,  and  an  excitant  of  calorification.  In  cases  where 
there  is  enfeebled  spinal  innervation  and  consequent  respiratory 
function,  nux  or  strychnia  will  be  thought  of  as  remedies.  Sense 
of  oppression  about  the  prsecordia,  increased  difficulty  of  respi- 
ration when  asleep,  tendency  to  retention  of  urine,  slow  move- 
ment of  the  bowels,  and  nausea,  are  indications. 

Stimulants.  There  are  a  few  stimulants  which  can  be  used 
with  advantage  to  stimulate  heat  production,  but  their  use  is  lim- 
ited. Alcoholic  stimulants  are  very  rarely  used  in  diseases  of 
children,  and  possibly  the  only  cases  in  which  we  would  think  of 
them  is  in  the  slow  convalescence  from  acute  disease.  I  am  sure 
that  their  use  during  the  progress  of  fever  or  inflammation  is  in- 
jurious. A  teaspoonful  of  brandy  or  good  whisky  in  four  to  six 
tablespoon fuls  of  water  (hot  or  cold,  as  suits  the  patient  best) 
sweetened,  sometimes  is  a  good  form. 

Tinct.  Xanthoxylum  may  be  used  occasionally,  as  may  a  Tinct. 
of  Asarum,  or  once  in  a  long  while  the  Comp.  Tinct.  of  Cajeput. 
Probably  the  best  child's  stimulant  will  be  found  in  the  old  mix- 
ture:  ]^  Comp.  Spirits  of  Lavender  oiij-,  Tinct.  Lobelia  5'-, 
water  and  syrup  .^iss.  Mix.  This  stimulates  the  respiratory 
nerves,  improves  the  circulation,  and  gives  an  agreeable  sense  of 
warmth. 

Salicylic  Acid.  Salicylic  acid  will  be  studied  under  the 
head  of  Anti-rheumatics.  Here  we  wish  only  to  note  its  eflect  in 
diminishing  the  temperature  of  the  body.  As  yet  we  know 
simply  the  fact  that  it  has  this  influence  in  some  cases,  but  in 
what  particular  cases,  and  what  the  specific  indications  are,  we  do 


62  DISEASES   OF   CHILDREN. 

not  know.  I  should  say  that  the  best  effects  are  to  be  expected 
when  the  patient  suffers  considerable  pain  in  the  extremities,  and 
when,  though  the  temperature  is  increased,  the  skin  is  inclined 
to  be  moist. 

Salicin.  This  remedy  stands  between  quinine  as  an  anti- 
periodic  and  salicylic  acid  as  an  anti-rheumatic,  and  may  be 
thought  of  when  with  periodicity  there  is  pain  of  a  rheumatic 
character.     In  such  cases  it  will  lessen  the  heat  of  the  body. 

Nitric  Acid.  This  remedy  will  be  fully  studied  with  the  next 
class,  though  it  is  difficult  to  properly  classify  it.  When  indi- 
cated— violet  colored  tongue — it  will  lessen  the  temperature  in 
a  very  marked  manner  in  cases  of  fever  or  inflammation,  and  in 
malarial  fever  will  prevent  the  recurrence  of  the  exacerbations. 
In  slow  infantile  remittents,  when  the  pulse  has  a  range  of  100° 
to  102°,  I  have  occasionlly  seen  the  most  marked  benefit  from  its 
administration. 

REMEDIES    WHICH  INFLUENCE  THE  RESPIRATORY    APPARATUS. 

The  function  of  respiration  is  one  of  the  most  important  in 
the  economy,  and  the  organs  engaged  in  it  may  be  regarded  as 
almost  the  center  of  life — in  the  olden  times  classified  as  "  noble 
organs."  Through  this  apparatus  the  blood  receives  its  supply 
of  oxygen,  and  is  freed  from  carbonic  acid  gas.  It  is  inti- 
mately associated  with  the  circulation,  both  in  its  structure  and 
its  innervation,  and  has  sympathies  with  the  entire  body, 

Remediesjnfluence  the  respiratory  apparatus  and  its  function 
directly,  as  they  influence  other  parts  of  the  body,  and  a  study 
of  them  in  this  relation  can  not  but  be  profitable.  The  principal 
of  these  are  : — 


Aconite, 

Stillingia, 

Senega, 

Veratrum, 

Lycopus, 

Scillae, 

Bryonia, 

Drosera, 

Sticta, 

Ipecacuanha, 

Sanguinaria, 

Rumex, 

Lobelia, 

Euphorbia, 

G-rindelia, 

Phytolacca, 

Phosphorus, 

Nitric  Acid. 

Eupatorium  Perfoliatum, 

Aconite.  We  have  made  a  study  of  this  remedy  two  or  three 
times,  and  need  but  note  here  its  direct  influence  in  relieving 
irritation  and  controlling  inflammation  of  this  apparatus.  It  has 
a   direct  action  upon   the   tonsils,  and  will  sometimes  arrest   a 


INFANTILE   THEEAPEUTICS.  63 

quinsy,  if  used  in  the  early  stage.  It  is  our  best  remedy  in 
laryngitis  or  croup,  giving  results  that  can  not  be  obtained  with 
the  old  nauseant  or  emetic  treatment.  In  mucous  croup  I  rarely 
think  of  using  any  other  internal  remedy,  and  in  the  pseudo- 
membranous form  it  will  be  one  of  the  most  important.  In 
acute  bronchitis  and  in  pneumonia  it  is  the  sedative  usually  indi- 
cated in  childhood,  and  forms  a  part  of  a  good  treatment. 

Veratrum.  Veratrum  is  the  remedy  selected  when  the  pulse 
is  full  and  frequent,  and  its  action  is  direct  in  arresting  inflam- 
mation of  any  part  of  the  respiratory  apparatus.  It  controls 
irritation  of  the  pneumogastric,  allays  cough,  and  improves  the 
respiratory  function. 

Bryonia.  This  remedy  influences  the  pleura  and  parenchyma 
of  the  lungs,  lessening  irritation  and  arresting  the  inflammatory 
process.  It  is  indicated  by  pain  in  the  chest,  sense  of  soreness, 
with  catching  pain  on  inspiration,  pleuritic  pain,  and  a  short 
harassing  cough.     The  flushed  right  cheek  is  a  good  indication. 

It  is  one  of  our  most  important  remedies  in  this  relation,  and 
will  be  in  frequent  demand  in  bronchitis,  pleuro-pneumonia,  and 
in  pleurisy. 

Ipecacuanha.  Ipecacuanha  exerts  a  specific  action  in  reliev- 
ing irritation  of  mucous  membranes,  and  we  employ  it  in  the 
first  stages  of  bronchitis  and  pneumonia  with  the  most  marked 
benefit.  In  years  past  I  have  treated  infantile  pneumonia  with 
Ipecac  alone  with  much  success.  It  was  rubbed  up  with  sugar, 
and  given  in  doses  of  one-fourth  to  one  grain,  sometimes  pro- 
ducing slight  nausea.  Now  we  use  the  tincture,  combining  it 
with  Aconite,  the  proportions  being — !^  Tinct.  Aconite  gtt.  iij., 
Tinct.  Ipecac  gtt.  v.  to  gtt.  x.,  water  Siv. ;  a  teaspoonful  every 
hour. 

Lobelia.  This  remedy  exerts  a  very  marked  influence  upon 
the  respiratory  apparatus,  improving  the  innervation  and  circu- 
lation. The  indication  is— an  oppressed  respiration,  congestion, 
increased  mucous  secretion,  moist  blowing  sounds,  mucous  rattling 
in  the  chest.  When  patients  are  old  enough  to  complain  it  is  of 
a  sense  of  weight  and  oppression,  especially  about  the  prsecordia. 

Tlieniost  marked  benefit  is  obtained  when  there  is  a  iendoncy 
to  congestion,  and  when  the  respiratory  tubes  are  filled  with 
mucus.     In  asthenic  bronchitis,  when    the  child  breathes  with 


64  DISEASES   OF  CHILDREN. 

great  difficulty,  and  the  rattling  of  mucous  can  be  heard  all 
through  the  chest,  I  know  of  no  remedy  so  certain  to  give  relief. 
It  is  also  one  of  our  best  remedies  in  infantile  asthma. 

In  ordinary  practice  we  use  it  with  the  sedatives,  gtt.  v.  or 
gtt.  X.  of  a  tincture  of  the  seed  being  added  to  water  5iv.  In 
asthenic  bronchitis  and  in  asthma,  I  frequently  make  the  old 
prescription.  'B^  Tinct.  Lobelia  (seed)  5j.,  Comp.  Spts.  Lav- 
ender 5iij.,  Syrup  Siss.  Mix.  Give  in  small  portions,  frequently 
repeated,  just  short  of  nausea.  This  will  be  found  an  admirable 
form  for  the  remedy,  as  it  is  readily  taken,  is  kindly  received  by 
the  stomach,  and  it  relieves  nervous  irritation  and  gives  rest. 

A  description  of  Lobelia  would  not  be  complete  without  refer- 
ence to  its  old  use  as  a  nauseant.  For  this  use  in  diseases  of 
children,  I  prefer  the  acetous  tincture  to  other  preparations.  It 
is  prepared  in  the  proportion  of  four  ounces  of  the  herb  lobelia 
to  the  pint  of  dilute  acetic  acid,  or  vinegar ;  or  the  acetous  tinc- 
ture may  be  formed  into  a  syrup  by  the  addition  of  two  pounds 
of  sugar  to  the  pint. 

Given  in  nauseant  doses,  lobelia  relaxes  the  respiratory  pass- 
ages, and  thus  gives  temporary  ease  to  the  breathing.  In  croup, 
in  asthma,  in  bronchitis,  and  in  whooping-cough,  this  action  is 
very  important.  Continuing  this  nauseant  influence  there  is 
increased  secretion  from  the  mucous  membrane  of  the  respiratory 
passages,  and  it  is  thinner  and  less  tenacious  than  the  secretion 
during  the  inflammatory  process.  The  engorgement  of  the 
vessels  is  somewhat  relieved  by  the  secretion,  and  the  mucus  is 
removed  with  greater  ease. 

In  administering  the  nauseants  for  this  purpose,  they  should 
be  repeated  so  frequently  as  to  keep  up  a  continued  action  ;  for 
if  ffiven  at  Ions  intervals,  the  alternation  of  relaxation  and  de- 
termination  of  blood  proves  injurious;  and  to  obtain  this  action, 
they  should  never  be  given  to  produce  speedy  emesis ;  indeed 
emesis  is  not  desirable  in  any  case,  unless  to  remove  accumula- 
tions of  mucus  already  secreted. 

EiTPATOTiTTTM.  When  the  pulse  is  frequent,  full  and  free,  and 
the  skin  inclined  to  be  moist,  the  Enpatorium  will  be  found  a 
good  remedy  in  bronchitis  or  pneumonia. 

Phytolacca.  This  remedy  exerts  a  special  influence  upon 
the  faueos  and  pharynx — the  throat — and  whon  tliis  is  inflamed  or 


INFANTILE    THERAPEUTICS.  65 

irritated,  and  is  a  source  of  cough  or  respiratory  difficulty,  we 
think  of  Phytolacca.  A  pallid  tongue  with  red  spots,  sore 
mouth,  sore  throat,  enlarged  lymphatic  glands  or  soreness  or 
pain  of  mammary  glands,  associated  with  disease  of  the  respira- 
tory apparatus,  call  for  Phytolacca. 

Stillingia.  Specific  Indications. — Sense  of  rawness  and  tick- 
ling in  the  throat ;  sense  of  irritation  behind  the  fauces  or  the 
velum  pendulum. palati;  burning,  itching  of  the  larynx,  which 
causes  a  short  cough  and  inclination  to  hawk  and  free  the  throat; 
croupal  cough  and  voice. 

Dose. — 15*  Tinct.  Stillingia  gtt.  x..  Simple  Syrup  o'j.,  one- 
fourth  to  one-half  teaspoonful.  I  like  the  Linamentum  Stillingia 
(B^  Oil  of  Stillingia  5ij-,  Oil  of  Cajeput  5i.,  Oil  of  Lobelia  5ss., 
Alcohol  5j-  Mix)  in  doses  of  one- half  to  one  drop  on  sugar. 

Stillingia  is  one  of  our  best  remedies  for  the  relief  of  cough, 
when  it  is  caused  by  a  sense  of  irritation  of  the  throat.  We  use 
it  in  chronic  bronchitis,  in  acute  bronchitis  when  secretion  is 
established,  and  especially  in  laryngeal  disease,  and  croup.  Even 
the  external  application  over  the  larynx  will  cure  croup,  and  is 
much  safer  than  the  old  treatment.  Usually  I  administer  Aconite 
interually  and  apply  the  Stillingia  liniment  to  the  throat. 

Lycopus.  The  pulse  is  frequent  and  somewhat  full  or  hard, 
the  cough  paroxysmal,  expectoration  of  muco-pus,  difficulty  in 
urination,  hemorrhage  from  lungs  or  kidueys,  deposit  of  tubercle. 

Dose. — As  a  cough  medicine  I  administer  it  in  drop  doses  on 
sugar;  for  other  purposes — 'S^  Tinct.  Lycopus  gtt.  x.  to  5ij.; 
Alcohol  §ss.,  water  .^iijss  ;  a  teaspoonful  every  one  to  four  hours. 

I  like  the  action  of  Lycopus  very  much  in  chronic  bronchitis, 
pneumonia,  or  tendency  to  phthisis  pulmonalis.  It  relieves  the 
cough,  quiets  pain,  gives  rest,  diminishes  the  temperature,  and 
brings  the  pulse  down  to  a  normal  standard.  It  will  also  give 
good  results  in  chronic  inflammation  of  the  kidneys,  bladder 
and  urethra. 

Sanguinaria.  Specific  Indications. — A^  sense  of  burning  and 
constriction  in  the  fauces  or  pharj'^nx,  with  irritative  cough  and 
difficult  respiration.  The  patient  is  nervous  and  restless,  redness 
of  nose  with  burning  and  thin  acrid  discharge,  spots  of  bright 
redness  on  face  or  on  chest,  redness  and  burning  of  the  ears. 

Dose. — The  dose  will  depend  upon  the  action  wanted.  Many 
5 


66  DISEASES   OF    CHILDREN. 

times  I  use  it  in  very  minute  doses — 1^  Nitrate  of  Sanguinaria 
gr.  ss,  water  iv.5 ;  a  teaspoonful  every  two  or  three  hours,  (or 
Tiuct.  Sanguinaria  gtt.  ij.  to  gtt.  v.,  water  Si  v.)  In  other  cases  I 
-would  use  the  acetous  tincture  in  full  doses  to  nausea  for  a  tem- 
porary effect. 

Homoeopathic  Indications,  (3d  to  6th  decimal). — Congestion  of 
blood  to  the  head,  with  ringing  in  the  ears  and  flushes  of  heat. 
Sick  headache,  beginning  in  the  morning  with  vomiting  of  bile, 
worse  from  motion,  stooping,  noise  or  light.  Periodical  headache. 
Coryza,  with  loss  of  smell.  Nasal  catarrh.  Nasal  polypus. 
Ulcerated  sore  throat.  Tongue  feels  sore  as  if  burned,  coated 
white.  Sensation  of  emptiness  in  the  stomach  soon  after  eating. 
Croup.  Asthma.  Pneumonia  with  very  difficult  respiration, 
cheeks  and  hands  livid,  pulse  soft  and  easily  compressed. — 
Ehrmann. 

Like  the  Lobelia,  for  the  old  use,  I  prefer  the  acetous  tincture 
of  sanguinaria  to  any  other  preparation.  It  is  prepared  wath  two 
ounces  of  the  ground  root  to  one  pint  of  dilute  acetic  acid,  or  vin- 
egar. A  syrup  may  be  prepared  in  the  same  manner  as  named 
for  the  Lobelia. 

Sanguinaria  is  rarely  used  alone ;  but  in  combination  with  Lo- 
belia it  gives  us  our  most  efficient  nauseant  expectorant,  and  is 
the  remedy  we  prefer  in  cases  of  mucous  and  pseudo-membranous 
croup.  In  small  doses,  so  that  it  does  not  produce  nausea,  it  be- 
comes a  stimulant  expectorant,  and  will  check  secretion  from  the 
bronchial  mucous  membrane. 

Nitrate  of  Sanguinaria.  The  nitrate  of  sanguinaria  is  one 
of  the  few  really  good  concentrated  preparations.  It  is  rarely 
used  in  the  form  of  powder,  being  too  acrid ;  but,  combined  with 
simple  syrup,  in  the  proportion  of  one  grain  to  four  ounces,  it 
furnishes  a  very  desirable  remedy.  Its  action  is  rather  that  of  a 
stimulant  to  the  respiratory  apparatus,  and  it  should  not  be  used 
in  nauseant  doses.  The  dose  of  the  syrup  will  be  ten  drops  for  a 
child  two  years  of  age. 

Euphorbia.  This  remedy,  which  is  fully  studied  with  those 
which  influence  the  digestive  apparatus,  has  an  action  very  much 
like  ipecac,  and  may  be  used  to  quiet  irritation  of  the  bronchial 
tubes  and  to  check  profuse  secretion. 

Dose. — I|i  Euphorbia  Hypcricifolia  gtt.  v.  to  gtt.  x.,  water 
5iv.;  a  teasj)Oonful  every  hour. 


INFANTILE  THERAPEUTICS.  67 

Phosphorus.  This  remedy,  which  has  been  fully  studied  in 
other  relations,  influences  the  respiratory  apparatus  in  a  direct 
manner,  stimulating  a  better  innervation  and  circulation.  It 
may  be  prescribed  in  low  grades  of  inflammation  of  the  lungs 
and  bronchia  in  minute  doses  as — ^  Tinct.  Phosphorus  gtt.  j.  to 
gtt.  iij.,  water  5iv. ;  a  teaspoonful  every  hour. 

Senega.  Specific  Indications. — The  cough  is  deep,  succussive ; 
much  rattling  in  the  chest ;  free  expectoration  of  mucus,  or  muco- 
pus ;  skin  is  harsh  and  dry  and  the  epidermis  desquamates,  or  it 
is  relaxed  and  the  surface  looks  dull  and  dead. 

Dose. — The  Syrup  Senega  may  be  used  in  doses  of  one-fourth 
of  a  teaspoonful,  as  a  stimulant  to  the  respiratory  apparatus.  Or 
the  tincture  may  be  employed,  as — 1^  Tinct.  Senega  gtt.  v.  to  gtt. 
XX.,  water  5iv. ;  a  teaspoonful  every  one  to  three  hours. 

The  stimulant  influence  of  Senega  upon  the  throat  and  bron- 
chial mucous  membrane  is  well  known,  and  is  probably  its  most 
important  use.  For  this  purpose  I  prefer  to  use  it  in  the  form 
of  tincture  to  that  of  syrup  as  commonly  employed.  In  chronic 
bronchitis  with  profuse  secretion,  it  may  be  combined  with  small 
doses  of  Ipecac  and  Veratrum. 

Its  influence  upon  the  kidneys  and  reproductive  organs  needs 
to  be  studied,  and  I  have  no  doubt  some  important  uses  will  be 
found  for  it.  I  have  employed  it  in  squamous  disease  of  the  skin, 
and  like  its  action  very  much ;  it  is  one  of  a  very  few  remedies 
that  influence  these  diseases. 

SciLL^.  Specific  Indications. — Cough  with  secretion  of  a  yel- 
lowish muco-pus,  mucus  rattling  in  the  chest,  scanty  urine,  feeble 
circulation. 

Dose. — I^  Acetum  Scillse  Sss.,  Syrup  Siss. ;  from  one-fourth  to 
one-half  teaspoonful  every  one  to  three  hours. 

Homoeopathic  Indications^  (3d  to  6th  decimal). — Whooping 
cough,  sounding  loose,  with  sneezing  and  watering  of  the  eyes 
and  nose.  Catarrhal  affections,  with  loose  sounding  cough  ;  more 
expectoration  in  the  morning.  Wheezing  breathing.  Pneumo- 
nia. Pleurisy.  Asthma.  General  anasarca.  Hydrothorax.  Fre- 
quent desire  to  urinate,  with  profuse  discharge  of  pale  urine. — 
Ehrmann. 

Sticta.  Specific  Indications. — The  patient  complains  of  pain 
in  the  shoulders  extending  to  neck  and  back  of  the  head ;  the 


68  DISEASES  OF  CHILDREN. 

child  will  be  observed  to  draw  its  shoulders  upward,  throw  the 
head  backward  and  move  it  uneasily.  There  is  a  harsh,  drv  cough, 
evidently  from  irritation  and  not  to  remove  secretion. 

Dose. — ^  Tinct.  Sticta  gtt.  v.,  water  Siv. ;  a  teaspoonful  every 
one  to  three  hours. 

Homceopathic  Indications  (3d  to  6th  decimal.)  Dry  coiyza, 
with  constant  desire  to  blow  the  nose.  Chorea,  constant  invol- 
untary motion  of  the  feet.  Excessive  dryness  of  the  nasal  pas- 
sages and  soft  palate ;  deglutition  painful  on  this  account.  Dry, 
hacking  cough. — Ehrmann. 

Sticta  is  a  very  fine  remedy  when  the  indications  are  clear  as 
above.  Why  a  pain  in  the  shoulders,  neck  and  to  occiput,  call 
for  sticta,  is  more  than  I  can  tell,  any  more  than  I  can  tell  why 
a  sick  person  should  have  a  pain  in  his  shoulder  and  back  of  neck 
and  head.  But  all  we  want  to  know  in  medicine  is,  this  relation 
between  a  definite  symptom  or  symptoms,  and  the  curative  ac- 
tion of  a  remedy.  Sticta  is  an  excellent  remedy  for  cough,  re- 
lieves irritation,  and  improves  respiration,  acts  kindly  upon  the 
stomach,  and  is  one  of  our  best  anti-rheumatics. 

RuMEX.  Specific  Indications. — Cough  with  sensation  of  full- 
ness in  the  chest,  sighing,  yawning,  efforts  to  take  a  full  inspi- 
ration. 

Lose. — !^»  Tinct.  Rumex  gtt.  v.,  water  5iv.;  a  teaspoonful 
every  one  to  three  hours. 

We  employ  Rumex  in  cases  of  had  blood,  with  disease  of  the 
skin ;  in  such  cases  it  is  certainly  one  of  the  most  valuable  alter- 
atives we  have.  In  these  cases  we  not  only  use  it  internally,  but 
as  a  local  application.  In  scrofulous  disease,  with  deposit  in 
glands  and  cellular  tissue,  with  tendency  to  break  down  and  fee- 
ble repair,  I  think  the  Rumex  unequaled.  Here,  also,  we  use  it 
internally  and  locally. 

Grindelia.  Specific  Indications. — The  breathing  is  labored 
and  asthmatic;  the  cough  hard  with  rattling  of  mucus;  sense  of 
•soreness  and  rawness  of  chest;  chronic  ulceration,  with  feeble 
venous  circulation. 

Do.sp. — ^.  Tinct.  of  Grindelia  3j-,  Glycerin,  Syrup  aa.  .5j. ;  one- 
fourth  to  one-half  teaspoonful  every  two  or  three  hours. 

Grindelia  may  be  employed  as  a  cough  remedy  in  fleshy  chil- 
dren with  feeble  circulation,  and  in  asthma  with  secretion  but 


INFANTILE  THEKAPEUTICS.  69 

want  of  power  to  expectorate.  It  is  a  stimulant  to  the  respira- 
tory apparatus  and  to  the  respiratory  function.  Locally  (in  the 
proportion  of  5j.  to  water  Oj.)  it  may  be  used  in  the  cure  of  old 
ulcers,  scrofulous  ulcers,  and  as  a  means  of  discussing  scrofulous 
enlargements. 

Hypophosphites.  The  compound  syrup  of  the  hypophos- 
phites  will  prove  an  admirable  remedy  to  relieve  irritation  of  the 
lungs  with  atony,  checking  cough,  and  giving  increased  respira- 
tory freedom.  At  the  same  time  it  improves  digestion,  blood- 
making  and  nutrition.  The  hypophosphite  of  lime  is  one  of  the 
most  certain  remedies  I  have  ever  employed  in  the  early  stages 
of  pulmonary  tuberculosis. 

EEMEDIES   WHICH   INFLUENCE    THE  DIGESTIVE  APPARATUS. 

It  cannot  be  too  often  impressed  upon  the  physican,  that  a  good 
condition  of  the  digestive  apparatus  is  of  first  importance  in  the 
treatment  of  any  form  of  disease.  If  stomach  and  bowels  are  in 
fair  condition  we  are  careful  not  to  disturb  them.  If  there  is 
anything  wrong  with  them,  the  first  object  of  treatment  is  to 
right  this  wrong. 

That  system  of  medicine  which  irritates  the  stomach  and  keeps 
it  in  a  state  of  unrest  is  intrinsically  bad,  increasing  the  suffering 
of  the  sick,  prolonging  disease,  and  greatly  increasing  the  mortality. 
That  system  of  medicine  which  disturbs  the  bowels,  causing 
irritation  or  atony,  wrongs  the  sick,  intensifies  suffering,  and 
increases  the  death  rate. 

If  any  one  will  call  up  his  past  experience  in  this  direction  he 
«  will  realize  the  truth  of  these  statements.  How  have  you  felt 
when  suffering  from  nausea  and  vomiting,  or  even  from  gastric 
irritation  short  of  this  ?  Did  you  find  it  conducive  to  comfort,  to 
rest,  to  appetite,  digestion  and  normal  functional  activity  ?  How 
would  you  like  a  teaspoonfnl  of  Lobelia  or  Sanguinaria  before 
each  meal — as  a  steady  diet  ?  How  have  you  felt  when  suffering 
from  a  good  old  fashioned  diarrhoea  of  six  to  ten  evacuations  a 
day?  Is  this  conducive  to  comfort,  to  rest,  to  appetite,  to  normal 
functional  activity?  AVhen  you  are  on  the  outside  of  two  or 
three  grains  of  Podophyllin,  one  or  two  drachms  of  compound 
powder  of  Jalap,  or  a  teaspoonful  of  Cascara,  was  it  comfort- 
ing to  the  inner  man,  and  did  it  give  strength  to  the  legs  and 
ability  to  work?     If  a  well  man  does,  not  take  kindly  to  these 


70  DISEASES  OF  CHILDREN. 

sensations,  and  finds  that  they  impair  his  life,  and  all  his  func- 
tional activities,  what  must  it  be  with  the  sick  man,  woman  or 
child?  These  are  questions  which  one  should  put  to  himself, 
and  then  see  that  they  are  answered. 

If  we  think  of  the  function  and  relations  of  this  apparatus 
we  can  see  additional  reasons  for  the  rule  I  have  named.  It  is 
the  inlet  for  all  the  fluid  and  the  foods  required  by  the  body,  and 
these  are  required  for  sustaining  the  life.  In  the  olden  time  it 
was  thought  that  the  sick  person  required  no  nourishment, 
but  we  now  know  that  the  sick  may  be  starved,  and  are  fre- 
quently starved  to  death.  A  certain  digestive  power  is  necessary, 
even  though  we  are  careful  to  furnish  food  that  requires  but 
little  digestion,  and  this  requires  a  reasonably  good  condition  of 
stomach  and  intestinal  canal. 

If  one  only  thinks  of  the  administration  and  absorption  of 
medicines  he  will  see  the  necessity  of  the  rule.  Unless  the  stom- 
ach is  in  fair  condition  medicines  are  not  kindly  received  and  ab- 
sorbed. The  right  remedy  may  be  selected,  which,  if  it  gained 
entrance  to  the  blood,  would  do  that  which  is  needed  for  the  cure ; 
it  is  given,  but  wholly  fails  because  absorption  can  not  take  place. 

The  sympathies  of  the  gastro-intestiual  canal  are  very  numer- 
ous and  very  sensitive,  indeed  it  seems  to  be  the  center  of  morbid 
sympathies.  If  a  distant  part  is  involved  in  disease,  the  stomach 
speedily  suffers ;  if  the  body  at  large  is  diseased,  the  stomach  suf- 
fers. It  is  abundantly  supplied  with  ganglionic  nerves,  and  the 
solar  plexus,  the  center  of  this  system,  lies  immediately  behind 
it,  and  is  almost  directly  influenced  from  it.  It  is  thus  related  to 
the  circulatory,  respiratory,  and  excretory  apparatus. 

EMETICS. 

The  act  of  emesis  seems  natural  to  the  nursing  child,  relieving 
the  stomach  of  repletion  and  nourishment  that  fails  to  digest. 
This  would  point  out  the  first  indication  for  emesis,  to  relieve  the 
stomach  of  food  that  can  not  be  digested,  or  that  is  undergoing 
decomposition. 

For  this  purpose  there  is  nothing  better  than  warm  water  given 
freely,  and  its  action  in  some  cases  of  emergency  assisted  by  tick- 
ling the  fauces  with  the  finger.  A  solution  of  common  salt  is 
also  very  good  in  such  cases,  and  leaves  no  bad  influence. 

The  second  indication  for  the  use  of  an  emetic  is,  when  there 
are  morbid  accumulations  in  the  stomach,  from  undigested  and 


INFANTILE  THERAPEUTICS.  71 

decomposing  food,  or  from  an  increased  secretion  of  gastric  mu- 
cus. It  is  met  with  occasionally  in  the  first  stages  of  severe  dis- 
ease and  is  an  unfavorable  complication,  for  such  condition  of  the 
stomach  precludes  the  taking  and  digesting  of  food,  and  the  proper 
appropriation  of  remedies.  Frequently,  in  such  cases,  the  medi- 
cines given  will  be  ejected  from  the  stomach  two  or  three  times 
a  day,  or  may  not  be  tolerated  at  all. 

The  third  indication  for  the  use  of  an  emetic  is,  for  the  removal 
of  material  from  the  respiratory  organs.  This  is  generally  mucus, 
occasionally  mucus  and  pus.  The  emetic  is  only  employed  in 
this  case,  when  we  have  such  evidence  of  the  loosening  of  the 
mucus  as  will  lead  us  to  believe  that  it  may  be  removed  in  this 
way.  Emetics  are  employed  in  nauseant  doses  to  aid  in  soften- 
ing, diminishing  the  plasticity,  and  loosening  such  accumulations. 

The  fourth  indication  for  the  use  of  an  emetic  is,  to  rouse  the 
nervous  system  from  severe  depression,  and  restore  a  uniform  cir- 
culation of  blood.  For  this  purpose  it  is  employed  in  scarlatina 
maligna,  in  the  severer  forms  of  rubeola  and  variola,  and  occa- 
sionally in  other  diseases. 

Ipecacuanha.  I  administer  ipecac  to  fulfill  the  second  indica- 
tion of  an  emetic.  It  is  given  in  the  form  of  powder,  mixed 
with  warm  water,  and  assisted  in  its  action  by  warm  water  or 
some  warm  tea.  The  dose  for  a  child  two  years  old,  will  be  from 
three  to  five  grains ;  for  an  infant,  half  to  one  grain. 

Acetous  Tincture  of  Lobelia  and  Saguinaria. — !l^  Lo- 
belia, Sanguinaria,  Ictodes,  aa.,  Sij.;  distilled  vinegar,  Oij.; 
alcohol,  5ij.;  make  Oij.  of  tincture  by  percolation;  dose  from  five 
to  thirty  drops. 

To  fulfill  the  third  and  fourth  indications  for  an  emetic,  I  pre- 
fer this  preparation  to  any  other  that  I  have  employed.  It  is 
repeated  every  five,  ten,  or  fifteen  minutes,  until  thorough  emesis 
is  produced,  and  its  action  is  aided  by  warm  drinks. 

After  t"he  use  of  any  emetic,  the  child  should  have  warm  drinks 
for  some  hours,  but  it  is  not  necessary  that  they  should  be  ob- 
jectionable to  the  taste ;  a  thin  corn  meal  gruel  or  common  tea, 
or  hot  water,  does  very  well. 


72  DISEASES  OF  CHILDREN. 

CATHARTICS. 

The  employment  of  cathartic  medicines  for  every  ailment,  and 
in  all  conditions,  was  not  only  an  absurd,  but  a  very  injurious 
practice.  It  arose  from  a  misconception  of  the  use  of  the  intes- 
tinal canal.  Instead  of  being  a  cloaca  or  drain  for  the  effete 
materials  of  the  body,  it  performs  the  most  important  part  of  the 
process  of  digestion;  as  an  excretory  organ  its  function  is  less 
than  the  skin,  and  two-thirds  less  than  the  kidneys. 

Cathartics  act  upon  the  entire  digestive  tract,  and  in  a  manner 
subversive  of  natural  processes.  As  the  function  of  digestion  is 
so  important  to  health,  furnishing  the  material  for  the  nutrition 
of  all  structures,  we  should  be  very  careful  how  we  interrupt  it 
and  set  up  unnatural  actions. 

The  frequent  use  of  cathartics  depends  somewhat  on  the  em- 
pirical benefit  that  follows  their  use  in  slight  diseases.  A  person 
has  a  headachej  a  cathartic  is  taken,  and  the  next  day  he  is  well ; 
or  he  has  an  indigestion,  and  a  cathartic  preventing  his  eating 
for  the  time  being,  makes  him  feel  better  in  a  day  or  two;  or  he 
has  caught  cold,  and  an  active  cathartic,  acting  as  a  derivative, 
gives  relief.  But  in  these  cases  the  influence  is  more  apparent 
than  real,  time  and  abstinence  from  food  being  the  important 
requirements. 

It  may  be  asserted  that  a  person  in  the  habitual  use  of  cathar- 
tics can  not  enjoy  good  health,  and  that  the  occasional  use  is 
injurious  in  the  same  proportion.  I  hold  that  they  should  never 
be  employed  unless  there  is  a  special  indication  for  their  use, 
which  indication  we  will  now  consider. 

The  first  indication  for  the  use  of  a  cathartic  is,  to  remove 
accumulations  from  the  bowels  that  are  proving  irritant.  These 
are  more  frequently  of  undigested  food  with  the  natural  secre- 
tions. The  symptoms  are,  an  uneasiness  of  the  child,  manifestly 
from  the  abdomen  ;  impaired  or  arrested  appetite,  and  digestion ; 
a  uniformly  coated  tongue,  usually  with  a  yellowish  shade  ;  and 
occasionally  a  peculiar  puffy,  expressionless  appearance  of  the  face. 

A  cathartic  is  never  indicated  when  the  child  is  well,  though 
the  bowels  have  not  moved  for  days. 

The  second  indication  for  the  use  of  a  cathartic  is,  to  produce 
revulsion  or  counter-irritation  in  case  of  serious  disease  of  im- 
portant organs.  Thus,  in  the  ])ast,  it  was  the  principal  means  of 
reachino'  a  determination  of  blood  to  the  brain,  inflammation  of 


INFANTILE  THEEAPEUTICS.  73 

the  brain,  congestion  of  the  brain,  and  occasionally  inflammation 
of  other  parts.  Our  means  of  cure,  and  especially  of  reaching 
these  diseases,  have  so  increased  that  this  use  of  cathartics  will 
be  rare. 

The  third  indication  for  the  use  of  a  cathartic  is,  to  promote 
the  absorption  of  dropsical  effusions.  Even  this  use  is  becoming 
obsolete  by  the  discovery  of  specific  medicines  for  this  purpose, 
without  disturbance  of  the  digestive  tract. 

Cathartic  medicines  are  employed  in  small  doses  to  stimulate 
the  digestive  tract,  and  increase  its  innervation  and  circulation. 
They  increase  the  secretion  of  the  digestive  fluids  and  thus  im- 
prove digestion,  and  at  the  same  time  increase  the  activity  of  its 
excretory  glandulse.  For  such  purpose  the  remedy  is  thoroughly 
triturated  with  sugar,  or  sugar  of  milk,  and  the  dose  is  below 
that  which  would  prove  laxative.  Used  in  this  way,  some  of 
this  class  furnish  the  most  certain  and  efiicient  alteratives. 

Amygdalus.  Specific  Indications. — There  is  irritation  of 
stomach  with  nausea,  vomiting,  sense  of  heat  and  burning.  The 
tongue  is  elongated  and  pointed,  with  reddened  tip  and  edges. 

Dose. — We  prefer  an  infusion  of  the  fresh  bark  of  the  green 
twigs  in  half  teaspoonful  doses,  but  the  tincture  may  be  used  in 
the  proportion  of  gtt.  x.  to  gtt.  xx.,  water  Siv.,  (a  little  ice  may 
be  added),  in  doses  of  half  to  one  teaspoonful  every  fifteen  to 
thirty  minutes. 

The  peach-tree  bark  will  be  found  an  excellent  remedy  to 
relieve  irritation  and  determination  of  blood,  with  its  attendant 
nausea  and  vomiting.  As  it  relieves  gastric  irritation  it  will  be 
found  to  give  rest  to  the  nervous  system,  and  a  better  circulation 
of  blood. 

Kheum.  Specific  Indications. — There  is  nausea,  vomiting,  un- 
easy sensation  in  stomach,  irregularity  of  bowels,  diarrhoea,  with 
light  colored  discharges. 

Dose.—^i  Tinct.  Rheum  gtt.  v.  to  gtt.  xx.,  water  .?iv. ;  half 
to  one  teaspoonful  every  half  hour  or  hour,  or  compound  powder 
of  Rhubarb  Sj.,  boiling  water  Siv.;  make  an  infusion  and  strain, 
and  give  in  half  teaspoonful  to  teaspoonful  doses. 

Homoeopathic  Indications  (3d  to  6th  decimal.)  Sour  smelling 
diarrhoea  in  children.  Colicky  pains  before  or  during  stool. 
Difficult  dentition.  Longing  for  various  things,  but  the  first 
morsel  satisfies. — Ehrmann* 


74  DISEASES  OF    CHILDREN. 

Rhubarb  is  an  old  and  favorite  remedy  with  our  school.  The 
old  compound  powder  in  infusion  was  used  to  relieve  irritation 
of  the  stomach,  check  nausea  and  vomiting,  and  cure  diarrhoea. 
For  the  first  purpose  it  was  used  in  small  doses  frequently  re- 
peated ;  for  the  second  it  was  continued  in  teaspoonful  doses  until 
the  discharges  had  the  color  of  the  medicine,  then  less  frequently. 
Diarrhoea  from  cold  was  readily  relieved  by  it,  and  it  would  cure 
the  simpler  cases  of  cholera  infantum  or  summer  complaint.  The 
tincture  will  sometimes  be  found  an  excellent  stomachic,  improv- 
ing digestion  as  well  as  relieving  irritation. 

Lobelia.  In  very  minute  doses  Lobelia  allays  irritation  of 
the  stomach  and  checks  nausea  and  vomiting.  When  the  tongue 
is  broad  and  full — atonic — the  remedy  will  sometimes  (minute 
doses)  act  as  a  tonic  and  improve  digestion.  Its  action  as  an 
emetic  has  been  referred  to. 

Ipecacuanha.  Specific  Indications. — There  is  irritation  of 
stomach,  small  or  large  intestine,  with  determination  of  blood. 
Nausea,  vomiting,  diarrhoea,  dysentery;  the  discharges  in  each 
case  being  somewhat  violent  and  painful.  Violent  and  expulsive 
cough,  with  sense  of  irritation  and  burning  ;  mucus  or  muco-pur- 
ulent  expectoration  ;  globular  sputa,  rusty  ;  hemorrhage. 

Dose. — ]^  Tinct.  Ipecac  gtt.  v.  to  gtt.  x.,  water  Siv. ;  a  tea- 
spoonful  every  hour. 

Homoeopathic  Indications  (3d  to  6th  decimal.)  Constant  sensa- 
tion of  nausea,  with  vomiting  of  mucus,  bile  or  blood ;  the  nau- 
sea continues  after  vomiting.  Colic  and  diarrhoea,  stools  look 
like  yeast,  smelling  sour.  Suffocative  attacks  of  breathing,  res- 
piration oppressed,  anxious,  quick  ;  cough,  with  rattling  of  mucus 
in  the  bronchial  tubes.  Intermittent  fever,  nausea  and  vomiting 
predominate;  chill  with  thirst,  followed  by  fever;  cases  in  which 
quinine  has  failed. — Ehrmann. 

Ipecac  is  a  favorite  remedy  in  disease  of  the  stomach  and  in- 
testinal canal.  It  relieves  irritation  and  quiets  nausea,  checks 
vomiting,  and  improves  the  functional  activity  of  the  stomach. 
It  is  a  very  certain  remedy  in  diarrhoea  from  irritation,  with  de- 
termination of  blood,  or  muco-enteritis,  from  the  simplest  form 
to  the  severer  cases  of  cholera  infantum.  It  is  also  a  prominent 
remedy  in  dysentery,  quieting  irritation,  relieving  pain,  and 
lessening  the  frequency  of  the  discharges.  In  all  of  these  cases 
we  generally  use  it  in  combination  with  Aconite. 


INFANTILE  THERAPEUTICS.  •  75 


/ 


Euphorbia  Hypericifolia.  Specific  Indications. — Diarrhoea, 
sense  of  heat  iu  stomach  and  abdomen ;  abdomen  is  hot  to  the 
hand,  some  tenesmus  with  discharges,  which  are  at  times  acrid. 
Bronchitis,  with  thin,  acrid  secretion. 

Dose. — I^  Tinct.  Euphorbia  gtt.  v.  to  gtt.  xx. ;  water  Siv. ;  a 
teaspoonful  every  one  to  three  hours. 

The  Euphorbia  is  a  most  excellent  remedy  in  the  treatment  of 
cholera  infantum  and  in  diarrhoea,  filling  a  similar  place  to  Ipecac. 
In  some  years  it  will  be  found  preferable  to  this  remedy,  in  other 
years  the  Ipecac  will  prove  the  best. 

CoLOCYNTH.  Specific  Indications. — Wandering  pains  in  the 
abdomen,  seemingly  in  the  course  and  from  contraction  of  the 
intestine ;  the  intestines  are  felt  to  change  their  position ;  noise 
from  the  movement  of  the  intestinal  contents ;  tormina  and  tenes- 
mus ;  dragging  from  the  umbilicus ;  frequent  desire  to  stool  from 
pressure  in  the  rectum,  with  burning  sensations. 

Dose. — IB^  Tinct.  Colocynth  gtt.  ij.  to  gtt.  v.  water  .*iv. ;  a  tea- 
spoonful  every  one  to  three  hours. 

Homceopathic  Indications,  (3d  to  6th  decimal). — Violent  pain 
in  the  abdomen,  causing  the  patient  to  bend  double ;  diarrhoea, 
worse  after  eating  or  drinking,  stools  frothy,  smelling  acid  or 
putrid;  dysentery,  discharges  of  mucus  and  blood  with  tenesmus, 
morbus  coxalgia ;  when  there  is  a  sensasion  as  of  being  encircled 
with  an  iron  band ;  urine  viscid ;  general  shortening  of  the  ten- 
dons.— Ehrmann. 

With  the  symptoms  as  above  named,  Colocynth  is  an  excellent 
remedy  for  diarrhoea  and  dysentery,  and  for  colic.  It  relieves 
pain,  checks  the  discharges,  and  promotes  normal  functional  ac- 
tivity. In  infantile  colic,  with  free,  acrid  discharges,  it  will  be 
found  an  admirable  remedy  if  the  dose  is  very  small,  gtt.  j.  to 
water  .5iv.,  or  a  Homoeopathic  dilution  is  used. 

Hamamelis.  This  remedy  has  been  fully  studied,  and  we 
notice  it  here  as  a  remedy  which  gives  tone  to  stomach  and  intes- 
tinal canal,  allaying  irritation  and  promoting  functional  activity. 
It  may  be  used  when  the  child  persistently  throws  up  its  food 
mixed  with  mucus ;  in  diarrhoea  with  large,  light  colored  dis- 
charges, and  when  there  is  prolapsus  ani.  If  the  abdomen  is 
full  and  doughy,  the  remedy  (distillate  or  Pond's  Extract)  may 
be  used  as  a  local  application,  and  if  there  is  relaxation  of  the 


76  DISEASES  OF  CHILDREN. 

perineum  with  prolapse  of  the  bowel,  it  may  be  locally  applied  to 
the  parts. 

Chionathus.  Specific  Indications. — Fullness  in  right  hypo- 
chondrium ;  pain  in  hypochondria,  extending  to  umbilicus ;  pain 
in  right  shoulder ;  yellow  (jaundice)  coloration  of  eyes  and  skin ; 
colic  with  excessively  green  discharges  from  the  bowels;  high 
colored  urine,  coloring  the  clothing  yellow. 

Dose. — The  dose  will  vary  from  gtt.  v.  in  water  Si  v.,  a  tea- 
spoonful  every  one  or  two  hours,  to  gtt.  j.  to  gtt.  v.  at  a  dose. 

The  Chionanthus  will  be  found  a  most  valuable  remedy  in  the 
treatment  of  jaundice,  and  those  painful  affections  of  the  bowels, 
associated  with  irregular  action  of  the  liver.  When  the  child 
suffers  with  infantile  dyspepsia,  and  there  is  fullness  in  the  region 
of  the  liver,  it  may  also  be  employed. 

UvEDALiA.  Specific  Indications. — Enlargement  of  the  spleen ; 
full  abdomen,  doughy ;  enlargement  of  the  liver  (liver-grown)  ; 
enlargement  of  any  part,  the  circulation  being  feeble  and  the 
tissues  atonic. 

Dose. — For  children  I  only  recommend  it  as  a  local  application, 
the  affected  part  being  thoroughly  rubbed  Avith  the  ointment  of 
Uyedalia,  or  with  one  part  of  the  tincture  to  two  or  three  parts 
of  cod-liver  or  sweet  oil. 

With  the  indications  named  there  is  no  remedy  equal  to  it.  I 
have  seen  the  enlarged  spleen  in  the  malarial  fevers  of  infancy  as 
early  as  the  third  month,  and  it  will  be  found  more  frequently 
than  physicians  suspect.  With  this  disease  of  the  spleen  the 
patient  can  not  easily  be  cured  of  the  fever,  or  if  the  fever  were 
stopped  he  would  still  suffer  from  impaired  blood-making  (lukse- 
mia).  It  is  also  valuable  in  chronic  inflammations  of  any  part, 
the  circulation  being  feeble,  and  tissues  atonic. 

Nux.  This  remedy,  fully  described  in  the  first  class,  has  a 
direct  action  upon  the  gastro-intestinal  canal.  It  is  indicated  by 
evidences  of  atony,  and  an  enfeebled  circulation.  Nausea  and 
vomiting  with  a  pallid,  expressionless  face,  is  speedly  relieved  by 
minute  doses,  as  gtt.  j.  to  water  Siv.  We  use  it  in  the  cure  of 
diarrhoea,  M'hen  the  discharges  are  large,  the  abdomen  full  and 
relaxed,  and  when  there  is  pain  simulating  colic. 

It  is  one  of  our  best  remedies  for  infantile  colic^  if  there  are 


INFANTILE  THEEAPEUTICS.  77 

no  evidences  of  irritation  and  determination  of  blood.  The  pulse 
is  feeble,  the  extremities  cool,  and  abdomen  full. 

It  is  an  excellent  stomachic,  and  if  an  indigestion  depends 
upon  an  enfeebled  innervation  and  circulation,  the  patient  will  be 
benefited  by  it.  A  sallow,  expressionless  face,  yellowness  about 
the  mouth,  slight  yellowness  of  the  eyes,  and  clay-colored  dis- 
charges are  indications  for  Nux. 

In  cholera  infantum  we  say  that  Nux  is  the  remedy  when  there 
is  atony  of  the  bowels,  with  feeble  circulation.  Aconite  where 
there  is  irritation  with  determination  of  blood ;  Ipecac  or  Eu- 
phorbia being  associated  with  either. 

Chelidonium.  Specifio  Indications. — Fullness  in  hypochon- 
drium,  tongue  much  enlarged  and  somewhat  pale ;  mucous  mem- 
branes full  and  pale ;  skin  full  and  sallow,  sometimes  greenish ; 
tumid  abdomen;  light  colored  feces;  no  abdominal  pain ;  urine 
pale,  but  cloudy  and  of  high  specific  gravity. 

Dose. — ^i  Tinct.  Chelidonium  gtt.  v.  to  gtt.  xv.,  water  Siv.,  a 
teaspoonful  every  two  or  three  hours. 

Homceopathic  Indications,  (3d  to  6th  decimal). — A  fixed  pain 
under  the  inner  and  lower  angle  of  the  right  shoulder  blade,  in 
chest  or  liver  affections  ;  orbital  neuralgia  of  the  right  side,  with 
profuse  lachrymation  ;  great  sense  of  tightness  around  the  neck 
above  the  larynx,  hindering  deglutition ;  constipation,  stools  like 
sheep's  dung ;  gallstones  with  jaundiced  complexion  ;  reddish  or 
greenish  urine. 

PoDOPHYLLiN.  Spccific  Indications. — The  tongue  is  full,  face 
full,  abdomen  full,  veins  full ;  enfeebled  innervation  through  the 
sympathetic;  dull  pain,  dull  headache,  dizziness. 

Dose. — In  diseases  of  children  I  prefer  a  second  decimal  tritu- 
ration, which  may  be  given  in  doses  of  from  one-eighth  of  a  grain 
to  one  grain.  In  older  children  granules  containing  1-40  of  a 
grain  of  Phodophyllin  with  1-8  grain  of  Hydrastia  will  some- 
times prove  beneficial  as  a  stimulant  to  the  stomach  and  intestine. 

Hommpathic  Indications  (3d  to  6th  decimal.)  Depression  of 
spirits.  Giddiness,  with  sensation  of  fullness  over  the  eyes. 
Difficult  dentition,  very  offensive  stools,  moaning  during  sleep, 
half  closed  eyes  and  rolling  the  head  from  side  to  side.  Diarrhoea, 
especially  in  the  morning  or  soon  after  eating.  Prolapsus  ani; 
Prolapsus  uteri.  Pain  in  the  ovarian  region.  Suppression  of 
the  menses,  with  bearing  down  sensation,  bettei*  when  lying  down. 


78  DISEASES  OF    CHILDREN. 

Pain  in  the  sacrum,  with  uterine  troubles.  Whooping  cough, 
with  constipation  and  loss  of  appetite. — Ehrmann. 

We  employ  Podophyllin  and  Podophyllum  as  a  stimulant  to  the 
sympathetic  nervous  system,  improving  innervation  to  all  parts 
supplied  with  ganglionic  nerves.  The  indications  for  its  use  in 
wrongs  of  the  digestive  apparatus  are  those  of  atony — full  expres- 
sionless tongue,  full  abdomen,  impaired  functional  activity.  In 
gastric  and  intestinal  dyspepsia,  with  these  evidences  of  atony,  a 
trituration  of  Podophyllin  will  be  found  an  excellent  remedy  The 
liver  may  be  stimulated  by  it,  the  portal  circulation  improved,  and 
the  spleen  relieved  of  its  overflow  of  blood. 

We  employ  it  as  a  remedy  for  diarrhoea  when  the  abdomen  is 
full  and  doughy,  the  discharges  light  in  color,  mucous,  or  contain- 
ing undigested  food.  Of  course  the  dose  is  small,  much  smaller 
than  most  physicians  use.  Some  cases  of  cholera  infantum  are 
cured  with  a  trituration  of  Podophyllin,  when  the  ordinary  treat- 
ment has  wholly  failed. 

Hydrastis.  Specific  Indications. — The  mucous  membranes 
are  flushed  ;  papillae  of  tongue  prominent  and  red ;  uneasiness  in 
stomach;  loss  of  appetite ;  impaired  digestion;  mucoid  matter 
with  stools ;  circulation  to  surface  and  extremities  feeble.  Sore 
mouth,  with  increased  mucus  secretion,  thick  and  tenacious  saliva ; 
sore  throat,  with  muco-purulent  secretion ;  sore  eyes,  with  muco- 
purulent secretion. 

Dose. — I  prefer  for  use  the  yellow  alkaloid  Hydrastis  or  Ber- 
berin,  which  is  very  soluble ;  one  grain  to  four  ounces,  make  a 
very  good  tonic,  and  is  about  the  strength  we  would  use  as  a  wash 
for  the  mouth  and  throat  or  as  a  collyrium. 

Homceopathic  Indications  (3d  to  6th  decimal.) — Sensation  of 
sinking  at  the  epigastrium  with  palpitation  of  the  heart ;  loss  of 
appetite  and  fainting  paroxysms;  yellowish  leucorrhoea  of  a  very 
tenacious  character,  sometimes  offensive;  malignant  and  cancer- 
ous forms  of  ulceration  ;  cancer  of  the  breast ;  constipation  with 
gastric  disturbance,  flatulence ;  small-pox  when  the  pustules  are 
dark  colored  and  there  is  great  prostration,  the  face  is  very  red 
and  facial  oedema  quite  marked ;  throat  very  sore. — Ehrmann. 

DioscoREA.  Specific  Indications. — Abdominal  pain,  shifting, 
paroxypmal,  relieved  by  pressure  or  by  supporting  the  abdomen 
and  keeping  the  patient  still.  Skin  soft,  and  feels  as  if  perspira- 
tion were  about  to  start ;  extremities  cold ;  uneasy  sensation  in 


INFANTILE   THERAPEUTICS.  79 

lower  part  of  the  chest  with  sense  of  constriction  in  epigastrium. 
Dose. — ^  Tinct.  Dioscorea  gtt.  v.  to  gtt.  x.,  water  5iv. ;  a  tea- 
spoonful  every  fifteen  minutes  to  an  hour. 

Dioscorea  is  an  excellent  remedy  in  infantile  colic,  if  it  pre- 
sents the  symptoms  named,  but  it  will  not  do  to  use  it  when  Nux 
or  Colocynth  are  indicated.  It  is  also  an  excellent  diaphoretic, 
but  when  used-for  this  purpose  I  administer  it  with  hot  water. 
Children  will  frequently  show  the  evidences  of  cold,  with  tendency 
to  cough,  and  the  respiratory  movement  will  be  observed  to  be 
short,  as  if  there  were  some  obstruction  in  the  lower  part  of  the 
lungs.     The  Dioscorea  is  a  good  remedy  in  this  case. 

Apocynum.  This  remedy  has  been  studied  in  the  second  class, 
as  it  influences  the  circulation.  We  employ  it  here  as  a  stimu- 
lant to  the  entire  gastro-intestinal  tract,  the  indications  being  a 
full,  tense  abdomen,  the  skin  glistening,  with  oedema  of  some 
part.  In  very  small  doses  it  increases  the  activity  of  the  bowels, 
and  overcomes  constipation,  and  if  the  dose  is  a  little  too  large 
will  cause  diarrhoea.  It  will  be  found  an  admirable  remedy  in 
acute  hydrocephalus,  as  it  is  in  the  chronic  form  of  the  disease. 
Irritation  of  the  nervous  system,  with  prominent  eyes,  fullness  of 
the  fontanells,  or  opening  of  the  sutures.  A  very  common  indi- 
cation for  Apocynum  is  oedema  of  the  eyelids,  or  that  wrinkled 
appearance  that  the  eyelids  present  when  they  have  been  swollen. 

ChamomilLiA.  Specific  Indications. — Infantile  dyspepsia  with 
irregularity  of  the  bowels ;  diarrhoea  with  flatulence  and  colic, 
discharges  contain  curdled  milk  or  other  undigested  food;  the 
person  is  irritable  and  restless  and  the  surface  alternately  flushed 
and  pale. 

Dose. — 'S^  Tinct.  Charaomilla  gtt.  v.,  water  Siv. ;  a  teaspoonful 
every  one  to  three  hours. 

Homoeopathic  Indications,  (3d  to  6th  decimal). — Great  sensi- 
bility to  pain,  making  the  patient  cross  and  uncivil;  children 
crying  and  fretting,  must  be  carried  about  in  order  to  be  appeased ; 
diarrhoea  which  smells  like  rotten  eggs,  and  looks  like  chopped 
eggs  and  greens,  especially  during  dentition  ;  one  red  cheek  while 
the  other  is  pale,  with  great  irritability  and  thirst;  flatulent  colic 
of  infants. — Erhmann. 


80  J>ISEASES  OF  CHILDREN. 

Iris,  Specific  Indications. — Fullness  of  thyroid  gland,  enkrge- 
ment  of  lymphatic  glands,  fullness  of  spleen,  grayish  or  coppery 
coloration  of  skin,  chylous  discharges  from  the  bowels. 

Dose. — T^  Tinct.  Irfs  gtt.  v.  to  gtt.  x.,  water  Siv. ;  a  teaspoon- 
ful  every  one  to  three  hours. 

Homoeopathic  Indications,  (3d  to  6th  decimal).— Sick  headache, 
with  vomiting  of  mucus,  tasting  sweet;  fullness  and  heaviness 
of  the  head,  head  and  face  cold ;  colic  relieved  by  bending  for- 
ward; brown  and  very  offensive  diarrhoea,  with  cutting  pains, 
nausea  and  vomiting,  emmission  of  fcetid  Mtus.— Ehrmann. 

Leptandria.  Specific  Indications.— Fullness  of  abdomen, 
doughy  sensation  to  touch ;  tongue  full,  pallid,  and  covered  with 
pasty  fur ;  stools  papescent  and  light  colored ;  tawny,  dirty  skin, 
dirty  eyes. 

Dose. — Leptandria  triturated  one  to  ten  may  be  given  in  half 
grain  doses,  or  the  tincture  may  be  used  with  glycerine  or  syrup 
so  that  the  patient  will  get  from  one-fourth  to  five  drops  at  a  dose. 

Homceopathic  Indications,  (3d  to  6th  decimal). — Black  fluid 
stools,  great  urging,  with  difficulty  in  retaining  the  stool ;  cutting 
pains  about  the  umbilicus ;  stools  like  tar ;  chronic  diarrhoea, 
worse  in  the  afternoon. — Ehrmann. 

Sulphate  of  Manganese.  Specific  Indications. —  A  pale, 
leaden  tongue,  dirty,  with  pendulous  abdomen  and  sluggish 
bowels;  jaundice  with  enlarged  liver,  fullness  and  weight  in 
right  hypogastrium,  dropsy. 

Dose. — For  administration  to  children  I  prefer  a  second  deci- 
mal trituration,  of  which  one-half  to  one  grain  may  be  given 
every  three  hours. 

Malt.  Specific  Indications. — The  digestion  of  calorifacient 
food  is  imperfect,  nutrition  is  impaired,  and  there  is  a  tendency 
to  scrofulous  or  tubercular  deposits. 

Dose. — Any  of  the  good  extracts  of  malt  may  be  used  in  doses 
of  one-fourth  to  one  teaspoonful  three  times  a  day.  Or  instead 
of  this  an  infusion  of  malt  may  be  prepared  and  given  to  the  child 
with  ks  food,  or  immediately  after  eating. 

It  is  believed  that  malt  contains  a  similar  ferment  to  the  saliva 
(ptyalin),  and  to  a  less  extent  to  the  pancreatic  fluid  (pancreatin). 
The  first  has  an  especial  influence  upon  starch,  chansiing  it  into 
grape  sugar;  the  second  will  peptonize  proteids,  eniulsifv  fats,  and 


IXFANTILE   THERAPEUTICS.  81 

convert  starch  into  sugar.  When  these  processes  are  imperfect 
and  children  suifer  from  impaired  nutrition,  and  cacophistic  or 
aplastic  deposits,  malt  has  been  found  to  give  good  results. 

Pepsin.  Specific  Indications. — Gastric  digestion  is  impaired, 
and  nutrition  is  imperfect;  there  are  eructations  of  food  and  gas, 
chylous  or  lienteric  diarrhoea,  abdomen  full,  urine  cloudy. 

Dose. — Of  a  good  pepsin  one-fourth  to  one  half  grain  may 
be  given  with  or  after  the  taking  of  food. 

Oxide  of  Zixc.  Specific  Indications. — The  tongue  has  a 
pasty  coat,  breath  bad,  eructations  of  food,  waterbrash,  gastro- 
dynia ;  secretions  of  mouth  become  so  acrid  that  they  excoriate 
the  mucous  membrane  and  lips,  and  produce  soreness  of  the 
nipple. 

Dose. — It  may  be  used  in  pill  form  (granules),  the  dose  being 
one-tenth  to  one-fourth  grain,  or  it  may  be  employed  in  the 
second  decimal  trituration  in  doses  of  one  grain. 

Ilomceojmthic  Indications  (3d  to  6th  decimal.) — Weakness  of 
memory.  Indisposed  to  converse.  Great  sensitiveness  to  noise. 
Hydrocephalus.  Soreness  of  the  eyes,  lids  and  inner  angle  of  the 
eyes,  great  itching.  Paralysis  of  the  upper  eyelid.  Otalgia, 
discharge  of  fetid  pus  from  the  ear.  Great  burning  in  stomach 
after  taking  sweet  things.  Great  greediness  when  eating,  can't 
eat  fast  enough.  Nausea  and  vomiting.  Metallic  taste  in  the 
mouth.  Patient  can't  keep  still,  must  be  in  motion  all  the  time. 
Varicose  veins  which  give  rise  to  fidgetiness  of  the  limbs. 
Puerperal  convulsions.  Scarlet  fever  when  there  is  retrocession 
of  the  eruption.  Child  unconscious  and  motionless.  Involun- 
tary jerking  and  twitching  of  the  muscles.  Grinding  of  the 
teeth.  Screaming  spells.  Occiput  very  hot  and  forehead  covered 
with  cold  perspiration.  Pulse  thread-like  and  difficult  to  count. 
— Ehrmann. 

Santonine.  Specific  Indications. — Fullness  of  the  upper  lip, 
white  line  around  the  mouth,  picking  at  the  nose,  foul  tongue, 
fetid  breath,  full  pendulous  abdomen,  tendency  to  retention  of 
urine. 

Dose. — As  a  remedy  for  worms  I  usually  combine  it  with 
Podophyllin  as  in  the  following — It  Podophyllin  gr.  j.,  Santo- 
nine  gr.  X.,  Sugar,  or  Sugar  of  Milk  5j. ;  triturate  thoroughly  and 
make  twenty  powders,  of  which  one  mav  be  given  night  and 
6 


82  DISEASES  OP  CHILDREN. 

morning.  In  retention  of  urine  I  have  it  triturated  with  sugar, 
■so  that  the  child  may  have  a  dose  of  one-eighth  to  one  half  graiu 
every  one  to  three  hours. 

Santonine  is  one  of  the  best  remedies  we  have  to  expel  the 
ascaris  lumbricoides,  and  to  so  influence  the  mucous  membrane 
that  the  intestine  will  not  be  a  habitation  for  these  vermin.  The 
combination  with  Podophyllin  is  very  good  when  there  is  atony 
with  increased  secretion  of  mucus,  but  if  there  is  irritation  of 
the  intestine,  the  remedy  may  be  triturated  with  sugar  and  a 
minute  portion  of  Ipecac. 

In  retention  of  urine  in  childhood  it  is  par  excellence  the 
remedy,  and  I  have  not  known  it  to  fail  in  an  experience  of 
twenty  years.  It  is  not  a  question  of  how  or  why  it  influences 
the  bladder,  but  the  fact  that  when  there  is  retention  of  urine 
from  one  to  three  doses  of  Santonine  will  cause  its  passage. 

Aloes.  Specific  Indications. — There  is  atony  of  large  intestine 
and  rectum,  mucoid  discharges,  prolapsus  ani,  pruritus  ani, 
ascaris  vermicularis. 

Dose. — The  remedy  is  a  very  nauseous  one,  and  it  is  difficult 
to  use  it  on  this  account.  A  second  decimal  trituration  may  be 
given  in  doses  of  one  grain,  or  even  a  trituration  of  one  to  ten 
may  sometimes  be  used.  To  remove  the  ascaris  vermicularis, 
and  break  up  the  conditions  under  which  it  propagates  itself,  I 
have  found  that  the  following  prescription  does  well :  It  Tinct. 
Aloes,  Comp.  Tinct.  Cardamom,  aa.  Sss.,  Syrup  5j-  ;  dose,  one- 
half  to  one  teaspoonful  until  it  acts  upon  the  bowels. 

Homoeopathic  Indications  (3d  to  6th  decimal.) — Sensation  of 
weight  or  heaviness  in  the  rectum ;  morning  diarrhoea,  very 
urgent,  must  go  at  once;  rumbling  and  rolling  in  the  bowels  be- 
fore stool ;  hemorrhoids  protruding,  feeling  hot  and  sore;  when 
urinating  sensation  as  though  something  had  passed  from  the 
bowels  ;  stools  consisting  of  jelly-like  mucus. 

REMEDIES  THAT  INFLUENCE    THE  URINARY   APPARATUS. 

We  find  in  practice  that,  in  a  majority  of  acute  diseases,  the 
function  of  the  kidneys  will  be  re-established  so  soon  as  the  cir- 
culation is  controlled.  Hence,  in  the  common  diseases  of  child- 
hood diuretics  are  not  required.  It  is  principally  in  the  malarial 
fevers,  and  in  zymotic  diseases  that  they  will  be  demanded.     In 


INFANTILE  THERAPEUTICS.  83 

chronic  disease,  with  deficient  waste  and  excretion,  they  become 
our  most  important  remedies. 

Here,  as  in  the  adult,  we  recognize  the  two  actions,  hydragogue 
and  depurant.  In  the  first,  the  water  of  the  urine  is  increased ; 
in  the  second,  the  solid  constituents  are  increased.  The  first  may 
be  used  to  lessen  the  volume  of  the  circulating  fluid,  to  remove 
irritations  of  the  urinary  passages  by  diluting  the  urine,  and  to 
promote  the  absorption  and  removal  of  dropsical  deposits.  The 
second,  increasing  the  solids  of  the  urine,  are  used  to  depurate 
the  blood  of  worn-out  and  imperfectly-formed  material.  They 
also  stimulate  the  processes  of  retrograde  metamorphosis,  and 
thus  facilitate  the  breaking  down  and  removal  of  tissue,  and  indi- 
rectly its  renewal. 

We  might  give  a  long  list  of  remedies  influencing  the  urinary 
apparatus,  but  a  few  will  serve  our  purpose,  as  in  diseases  of 
children  especially,  the  kidneys  will  do  their  work  if  the  general 
conditions  are  right.     The  agents  we  will  study  are : — 

Sweet  Spirits  of  Nitre,  Mentha  Viridis,    Cucurbita  Citrullus, 

Acetate  of  Potash,  Gelseminum,  Rhus  Aromatica, 

Eupatorium  Pur.,  Santonine,  Agrimonia, 

Hydrangea,  Apis,  Belladonna, 

Benzoate  of  Lithia,  Local  applications  to  the  Loins. 

Sweet  Spirits  of  Nitre.  I  name  this  remedy  first,  because 
it  has  been  employed  so  extensively,  and  with  good  advantage, 
in  diseases  of  childhood.  In  this  case  it  is  not  only  diuretic,  but, 
to  a  slight  extent,  sedative — lessening  the  force  and  frequency  of 
the  pulse.  It  is  only  in  the  simpler  forms  of  disease  that  I  would 
recommend  it.  To  two  ounces  of  water,  in  a  glass,  add  a  tea- 
spoonful  of  spirits  of  nitre,  keep  covered,  and  give  a  teaspoonful 
every  two  hours.  This  is  the  dose  for  a  child  from  one  to  two 
years  of  age. 

Mentha  Viridis.  Though  not  usually  regarded  as  of  much 
importance  by  the  profession,  and  as  having  but  feeble  diuretic 
properties,  I  think  in  diseases  of  children  it  will  be  found  one  of 
the  most  certain  of  remedies.  It  has  this  advantage,  that,  pre- 
pared in  strong  infusion  and  sweetened,  it  is  quite  palatable,  and 
it  may  be  given  freely  without  danger. 

I  give  it  alone  and  in  combination.  With  sweet  spirits  of  nitre 
a  very  powerful  hydragogue  action  may  be  obtained.  If  there  is 
irritation  of  the  urinary  apparatus,  I  generally  add  tincture  of 


84  DISEASES  OP  CHILDREN. 

Gelseminum  in  small  doses.  If  the  pulse  is  excited  I  give  Ye- 
ratrum  at  the  same  time.  Or,  if  there  is  congestion  with  ten- 
dency to  coma,  Belladonna. 

CucuRBiTA  CiTEULLUS.  An  infusion  of  watermelon  seeds 
is  a  very  mild  unirritating  diuretic  in  diseases  of  children.  The 
only  difficulty  we  find  in  using  it  is,  that  children  will  not  drink 
unless  they  are  thirsty,  and  in  sickness  they  are  very  particular 
what  they  drink,  and  may  not  like  watermelon-seed  tea  as  a  sub- 
stitute for  water. 

Acetate  of  Potash.  Specific  Indications. — The  tongue  is 
full,  pallid,  slightly  leaden,  and  coated  with  a  pasty  fur;  the 
abdomen  is  full  and  doughy,  and  the  skin  dirty. 

Dose. — ^  Acetate  of  Potash  5j-j  water  5iv. ;  a  teaspoonful 
every  two  or  three  hours,  with  as  much  fluid  as  the  patient 
can  be  persuaded  to  take. 

Of  the  class  renal  depurants,  Acetate  of  Potash  is  the  most  effi- 
cient. It  is  employed  to  increase  the  solids  of  the  urine,  and 
remove  the  waste  from  the  blood.  When  given  in  large  doses, 
and  for  some  time,  it  breaks  down  feeble  tissues,  and  thus  hastens 
the  removal  of  worn-out  material.  But  having  such  action,  it 
may  be  carried  too  far,  to  the  weakening  and  breaking  down  of 
sound  tissue,  or  to  the  removal  of  material  faster  than  it  can  be 
replaced.  It  is  a  good  remedy  in  its  place,  but  used  to  excess  it 
is  injurious. 

In  many  cases  it  may  be  added  to  the  child's  drink,  so  that  the 
necessary  quantity  will  be  taken  in  the  course  of  the  day,  without 
its  knowledge.  For  a  child  two  years  of  age  the  medium  quan- 
tity will  be  half  a  drachm,  each  twenty- four  hours. 
.  Citrate  of  potash,  bitartrate  of  potash,  nitrate  of  potash,  and 
acetate  of  soda  may  be  used  for  the  same  purposes. 

Santonine.  We  think  of  Santonine  as  a  vermifuge  only,  yet 
it  has  other  desirable  properties.  One  of  them  is.  its  influence 
over  the  bladder  in  retention  of  urine.  In  some  diseases  there 
is  sometimes  a  tendency  to  retention  which  ordinary  remedies 
will  not  reach,  and  which  at  last  proves  fatal.  Santonine  thor- 
oughly triturated  with  sugar,  in  doses  of  from  half  to  one  grain 
every  two  hours,  affijrds  very  certain  relief.  It  is  also  very  effijc- 
tual  in  relieving  burning,  scalding,  tenesmus,  and  other  unpleas- 
ant sensations  of  the  urinary  passages. 


INFANTILE   THERAPEUTICS.  85 

EuPATORiUM.  Specific  Indications. — There  is  a  sensation  of 
weight  and  dragging  in  the  loins,  retraction  of  testicles,  frequent 
desire  to  urinate,  scanty  secretion  of  urine. 

Dose. — I^  Tinct.  Eupatorium  gtt.  x.  water  Siv. ;  a  teaspoonful 
every  one  or  two  hours. 

When  there  is  a  continued  scanty  secretion  of  urine,  though 
the  general  wrongs  have  been  looked  after,  we  may  think  of  the 
Eupatorium.  The  indications  as  given  above,  will  be  found  a 
good  guide  to  its  administration. 

Gelseminum.  Gelseminum  has  been  studied  in  our  first  class, 
and  we  notice  it  here  as  a  remedy  directly  influencing  the  kidneys, 
relieving  irritation  and  determination  of  blood.  The  indications 
for  it  are,  sharp  pailis  in  the  loins  and  back,  frequent  desire  to 
pass  urine,  which  is  passed  in  very  small  quantities  v/ith  tenesmus. 

It  is  not  only  a  remedy  for  irritation  and  determination  of 
blood  to  the  kidneys,  but  for  irritation  of  any  part  of  the  urinary 
passages  as  well.  In  cystitis  it  is  a  favorite  remedy,  as  it  is  in 
irritable  (spasmodic)  stricture  of  the  urethra. 

Eryngium.  Specific  Indications. — Frequent  desire  to  pass 
water,  with  vesical  tenesmus,  contraction  of  abdominal  muscles, 
drawing  up  of  the  thighs,  scanty  urine,  acrid,  irritating  the  ex- 
ternal parts. 

Dose. — ^  Tinct.  Eryngium  gtt.  v.,  water  5iv. ;  a  teaspoonful 
every  one  to  three  hours. 

Eryngium  is  an  admirable  remedy  to  relieve  irritation  of  the 
bladder,  and  I  have  no  doubt  that  it  exerts  quite  as  strong  an 
influence  upon  the  pelvis  of  the  kidneys  and  ureters.  It  also 
increases  the  secretion  of  urine,  which  is  less  acrid  and  irritant. 

Belladonna.  This  remedy  has  been  fully  studied,  and  we 
notice  it  here  as  a  remedy  for  congestion  or  enfeebled  circulation 
of  the  kidneys,  and  for  diabetes  and  incontinence  of  urine.  In 
cases  where  the  patient  complains  of  fuljness,  weight  and  drag- 
ging in  the  loins  we  prescribe  Belladonna.  When  the  urinary 
secretion  is  too  free,  the  urine  of  low  specific  gravity,  the  admin- 
istration of  Belladonna  internally,  or  the  application  of  a  Bella- 
donna plaster  to  the  loins  is  good  treatment. 

In  incontinence  of  urine  this  remedy  has  given  most  excellent 
results,  especially  in  those  cases 'where  there  was  inability  to  hold 
the  urine  during  the  day,  and  a  dribbling  away  which  soiled 
the  clothing. 


86  DISEASES  OF  CHILDREN. 

.  Rhus  Aeomatica.  This  agent  is  highly  recommended  for 
incentinence  of  urine,  especially  for  nocturnal  incontinence.  It  is 
also  used  in  irritable  bladder;  in  chronic  cystitis  and  urethritis; 
in  phosphuria,  and  when  there  are  mucoid  discharges  in  the  urine. 
Dose. — ^  Tinct.  Rhus  Aromatica  gtt.  v.  to  5j.>  water  Sij. ;  a 
teaspoonful  every  two  or  three  hours. 

Aqeimonia.  Specific  Indications. — Renal  colic,  pains  ex- 
tending from  the  hypochondria  to  the  loins,  and  thence  down  to 
the  bladder.  Irritable  kidneys ;  irritation  of  kidneys  or  the 
urinary  passages,  with  cough ;  cough  attended  with  expulsion  of 
urine. 

Dose. — 'S^  Tinct.  Agrimonia  gtt.  v.  to  gtt  xxx.,  water  5iv. ;  a 
teaspoonful  every  one  to  three  hours. 

Hydrangea.  Specific  Indications. — Irritable  bladder  and 
urinary  passages,  urine  passed  with  difficulty  and  with  tenesmus, 
blood  in  the  urine,  strangury,  irritation  of  urinary  passages  with 
cough. 

Dose. — ^  Tinct.  Hydrangea  gtt.  v.  to  gtt.  x.,  water  .^iv. ;  a 
teaspoonful  every  one  to  three  hours. 

Apis.  Specific  Indications. — Itching  of  the  genitals ;  itching 
along  the  urethra  ;  burning  in  the  bladder;  itching  of  the  anus; 
itching  and  burning  of  the  skin  ;  eyes  itch  and  burn ;  child  wants 
to  rub  them  frequently. 

Dose. — I^  Tinct.  Apis  gtt.  ij.  to  gtt  v,,  water  .5iv. ;  a  tea- 
spoonful every  hour  to  three  hours. 

Homoeopathic  Indications  (3d  to  6th  decimal). — Burning  and 
stinging  pains  with  scanty  secretion  of  urine  ;  breathing  labored, 
with  fever  without  thirst ;  dropsy  without  thirst,  and  waxy  ap- 
pearance of  the  skin  ;  oedematous  swelling  of  the  face,  especially 
about  the  eyes;  hydrocephalus,  with  sudden  shrill  cries;  boring 
of  the  head  in  the  pillow,  squinting,  grinding  of  the  teeth,  urine 
scanty,  twitching  on  one  side  while  the  other  is  paralyzed. — 
Ehrmann. 

AVith  the  indications  as  above  named  the  Apis  will  be  found  an 
admirable  remedy.  I  have  seen  it  start  a  free  secretion  of  urine 
in  a  few  hours,  when  it  had  been  nearly  arrested.  It  relieves 
irritation  of  the  nerve  centers,  gives  rest,  improves  the  circula- 
tion, and  especially  removes  hypersesthesia  of  the  cutaneous 
nerves. 


INFANTILE  THERAPEUTICS.  87 

Benzoate  of  Lithia.  Specific  Indications, — There  is  diffi- 
cult uriuatioD,  discharge  of  mucus,  rauco-pus  or  phosphates  with 
the  urine;  the  skin  is  doughy  or  waxy ;  the  tongue  dirty;  the 
breath  fetid,  and  general  evidence  of  imperfect  waste  and  nutrition. 

J)ose. — It  may  be  given  to  a  child  two  years  old  to  the  amount 
of  one  grain  each  day  in  the  water  the  patient  takes. 

Homoeopathic  Indications  (3d  to  6th  decimal). — Urine  scanty,  of 
dark  brown  color,  and  strong  urinous  odor;  nocturnal  enuresis; 
rheumatism,  with  strong  smelling  urine ;  hypochondriasis,  sore 
throat  and  diarrhoea,  with  the  above  characteristic  urine. — 
Ehrmann. 

REMEDIES  THAT   INFLUENCE    THE  SKIN. 

It  is  hardly  necessary  to  call  attention  to  the  importance  of  a 
healthy  skin,  as  associated  with  good  health,  and  to  its  impairment 
as  a  frequent  cause  and  constituent  of  disease.  This  organ  not 
only  removes  a  large  amount  of  nitrogenized  waste,  but  it  also 
regulates  the  temperature,  and  assists  in  the  respiratory  function. 
If  its  function  as  a  regulator  of  the  temperature  (safety  valve) 
is  impaired,  we  will  have  a  wrong  of  this  condition  of  life  which 
will  work  a  wrong  of  every  function  of  life.  If  it  fails  to  do  its 
work  of  excretion,  the  blood  must  suffer  from  the  retained  ma- 
terial, unless  the  kidneys  and  bowels  do  vicarious  work.  Impair- 
ment of  the  skin  thus  imposes  additional  labor  upon  the  lungs. 

In  studying  the  pathology  and  therapeutics  of  the  skin  we  must 
not  forget  its  intimate  relationship  with  mucous  membranes. 
The  skin  and  mucous  membrane  may  be  regarded  as  one  piece — 
folded  in,  forming  the  internal  lining  or  envelope,  covering  the 
body  as  au  external  envelope.  The  sympathy  between  the  two  is 
so  intimate  that  wrongs  of  the  fekin  work  wrongs  of  mucous 
membrane,  and  wrongs  of  mucous  membrane  work  wrongs  of 
skin.  An  impairment  of  the  functions  of  the  skin  may  work 
such  wrong  of  mucous  membrane  as  to  imperil  life. 

We  see  this  illustrated  in  some  of  the  simpler  eruptions  upon 
the  skin.  A  child  suffers  from  heat,  or  some  of  the  simpler  forms 
of  erythema  or  urticaria,  but  as  long  as  it  is  out  freely  upon  the 
skin,  the  functions  of  the  body  are  well  performed.  From  some 
cause  the  eruption  disappears  (goes  in),  and  at  once  the  child  is 
very  sick,  has  bronchial  irritation,  croup,  or  intestinal  irritation 
with  diarrhoea.     A  cure  in  such  cases  will  come   from  bringing 


88  DISEASES  OF  CHILDREN. 

the  eruption  to  the  surface,  prevention  of  disease  will  come  by 
keeping  the  eruption  on  the  outside. 

The  remedies  we  will  study  in  this  connection  are  the  following: 


Baths, 

Sedatives, 

Rhus, 

Diluents, 

Stimulants, 

Apis, 

Asclepias, 

Inunctions, 

•Senega, 

Saffron, 

Nepeta, 

Sulphur, 

Belladonna, 

Serpentaria, 

Arsenic. 

Eupatorium, 

Sedatives.  In  proportion  to  the  frequency  of  the  pulse  and 
the  increase  of  temperature  is  the  arrest  of  secretion.  If,  there- 
fore, there  is  a  frequent  pulse,  the  first  step  toward  obtaining  a 
normal  action  of  the  skin  is,  to  bring  it  down  to  the  normal 
standard.  The  arterial  sedatives  thus  become  the  most  import- 
ant diaphoretic  means.  With  small  and  frequent  pulse  Aconite 
is  our  best  diaphoretic ;  with  a  full,  frequent  pulse  it  is  Veratrum ; 
with  an  oppressed  pulse  Lobelia,  etc. 

In  a  large  number  of  cases  of  fever  and  inflammation,  if 
proper  means  are  used  to  .lessen  the  frequency  of  the  pulse  and 
bring  the  temperature  to  a  normal  standard,  secretion  from  the 
skin  is  established  in  proportion  as  these  effects  are  obtaiued.  If 
secretion  does  not  start  as  the  pulse  comes  down,  very  mild 
diaphoretic  remedies  will  be  sufficient  to  accomplish  the  purpose. 
With  a  frequent  pulse  and  high  temperature  no  diaphoretics 
will  act. 

Stimulants.  There  are  cases  where,  from  a  feeble  general 
circulation,  and  an  enfeebled  skin,  secretion  can  not  go  on.  This 
will  be  known  by  the  dull  color,  want  of  elasticity,  colduess,  and 
want  of  sensibility.  In  such  cases  anything  that  will  stimulate 
the  general  circulation,  and  will  stimulate  the  skin  and  its  circu- 
lation, will  improve  functional  activity.  I  have  used  in  such 
cases  something  like  the  following,  with  good  results:  ^  Tinct. 
Lobelia  .5j.,  Comp.  Tinct.  Lavender  oiij-,  Syrup  Siss.;  give  in 
teaspoonful  doses,  mixed  with  hot  water  every  hour.  I^*  Tinct. 
Ipecac  gtt.  X.,  Comp.  Tinct.  Cardamom  .5ss.,  Syrup  Siss. ;  tea- 
spoonful  every  half  hour  or  hour,  with  hot  water.  An  infusion 
of  ginger  or  of  Asarum  canadense  may  sometimes  be  given. 

Baths.  We  have  already  studied  the  use  of  baths,  as  a 
means  of  rectifying  wrongs  of  the  temperature,  but  we  can  not 
learn  too  much   about  these  means,  and  a  little  repetition  will 


INFANTILE   THERAPEUTICS.  89 

not  be  injurious,  and  we  now  want  to  know  how  they  influence 
secretion. 

The  success  of  Eclectic  practice  has,  I  think,  depended  quite  as 
much  upon  the  skilled  use  of  the  bath,  as  upon  the  administra- 
tion of  internal  remedies,  and  from  the  days  of  Beach  great 
stress  has  been  put  upon  "  bathing  the  sick."  It  came  in  at  a 
time  when  water  was  thought  to  be  injurious,  whether  applied 
to  the  surface  or  given  as  drink,  for  water  and  mercury  were 
antagonistic  elements,  and  mercury  the  sick  must  have.  In 
simple  opposition,  therefore,  if  for  no  other  reason,  we  washed 
our  patients  frequently,  and  gave  them  as  much  water  as  they 
could  drink. 

The  Alkaline  Sponge  Bath. — "  The  alkaline  bath,"  was  the  one 
most  generally  recommended  and  used,  and  this  was  a  potash, 
not  a  soda  bath.  In  early  days  it  was  made  by  adding  wood- 
ashes  to  water  (broke  water)  so  as  to  render  it  slightly  slippery ; 
now  we  use  bicarbonate  of  potash.  It  has  a  very  kindly  influ- 
ence upon  the  skin,  softening  it,  lessening  the  temperature,  pro- 
motiqg  a  better  flow  of  blood  and  increased  secretion.  In  some 
cases  soda  may  be  substituted  for  the  potash  with  advantage, 
but  a^  a  rule  the  old  alkaline  bath  is  the  best.  There  are  cases 
in  which  the  skin  is  influenced  better  by  simple  soap  and  water. 

The  Acid  Sponge  Bath. — When  the  tongue  and  mucous  mem- 
branes show  a  deep-red  or  dusky  color,  and  the  skin  also  shows 
dusky  redness,  an  acid  bath  will  sometimes  be  preferable.  If  the 
ordinary  bath  is  used  it  seems  to  leave  the  skin  drier  and  harsher 
than  it  was.  If  we  now  add  a  portion  of  vinegar  to  the  water,  it 
softens  the  skin,  lessens  the  temperature,  and  aids  secretion. 

Cold  Wet-Sheet  Pack. — In  recent  disease  where  the  attack  is 
acute  and  the  patient  strong,  the  cold  wet  pack  may  be  used  to 
advantage.  The  temperature  is  increased,  the  pulse  frequent 
and  strong,  and  the  skin  dry.  The  only  objection  to  it  is,  the 
fear  of  the  parents  that  some  harm  may  follow,  and  the  indisposi- 
tion of  the  child  to  have  such  liberties  taken  with  it. 

Resolving  on  a  cold  wet  pack,  we  have  the  little  fellow  stripped, 
a  sheet  of  proper  size  wrung  out  of  cold  water  and  wrapped 
around  him,  and  then  tuck  him  in  his  crib  or  bed,  with  plenty  of 
covering.  Half  an  hour  to  one  hour  is  about  the  time  we  shonld 
allow  him  to  be  in  it,  when  he  may  be  thoroughly  dried  with 
rubbing,  and  have  dry  warm  clothing  put  on. 


90  DISEASES   OF    CHILDEEN. 

Local  packs  may  be  used  to  any  part  which  is  suffering  from 
increased  heat  and  arrested  secretion.  The  point  we  place  stress 
upon  is,  that  there  shall  be  a  vigorous  circulation.  It  will  not 
do  to  trust  to  the  reaction  to  obtain  a  good  circulation  and  temper- 
ature, though  sometimes  the  reaction  from  the  cold  is  sufficient 
for  this. 

Hot  Wet-Sheet  or  Blanket  Pack. — When  the  skin  is  feeble,  its 
circulation  impaired,  and  especially  when  we  want  to  bring  an 
eruption  upon  the  surface,  we  use  the  hot  blanket  pack.  Some- 
times an  internal  congestion  will  demand  speedy  means  of  relief. 
In  the  eruptive  fevers,  if  the  eruption  fails  to  make  its  appear- 
ance the  patient  becomes  dull,  sleepy  or  comatose,  and  the  skin 
has  a  dull  pallor  or  is  dusky — here  the  hot  pack  is  a  good  thing. 

In  using  this,  a  blanket  is  wrung  out  of  hot  water,  and  applied 
around  the  child,  which  is  then  warmly  covered  in  its  crib ;  in 
some  cases  mustard  may  be  added  to  the  water  to  make  it  more 
stimulant.  As  the  child  does  not  like  the  hot  application  any 
better  than  it  does  the  cold,  and  will  not  bear  it  hot  enough  for 
benefit,  we  sometimes  apply  the  hot  blanket  over  a  thin  under- 
shirt and  drawers  ;  it  can  then  be  very  much  hotter. 

Local  hot  packs  are  employed  when  parts  are  feeble,  and  have 
a  sluggish  circulation. 

The  Hot  Foot  Bath. — Every  person  thinks  that  he  or  she 
knows  all  about  the  use  of  this  simple  means,  but  yet  we  find  in 
practice  that  not  one  in  ten  can  use  it  so  as  to  benefit  a  child. 
The  adult  will  have  a  full  bucket  of  hot  water,  and  the  limbs 
covered  ;  the  child  will  have  one  or  two  inches  in  a  shallow  basin, 
not  very  hot,  and  the  limbs  exposed  up  to  the  body.  In  the 
majority  of  cases  the  nurse  dashes  the  water  upon  the  child's  legs 
with  the  hands,  thus  producing  rapid  evaporation,  and  of  course 
refrigeration.  Necessarily,  the  desired  influence  is  not  produced, 
and  very  frequently  it  has  the  contrary  effect  to  that  desired.  So 
confident  am  I  that  the  foot  bath  will  be  used  in  this  way,  that  I 
never  order  it  without  giving  specific  directions,  and  many  then 
misuse  as  above. 

Hot  Sponge  Baths.  Sponging  the  surface  with  water  as  hot  as 
it  can  be  borne  is  sometimes  a  most  admirable  stimulant  to  the 
surface,  and  very  much  better  than  the  hot  bath.  If  the  skin  is 
very  inactive,  with  a  feeble  circulation,  I  recommend  the  use  of 
hot  water  with  a  sponge  lightly  and  briskly  applied,  the  patient 
being  covered  with  a  blanket.     In  the  eruptive  fevers,  when  there 


INFANTILE   THERAPEUTICS.  91 

is  u  tardy  appearance  of  the  eruption,  no  better  means  can  be 
found  than  this;  in  some  cases  the  eruption  seeming  to  follow  the 
hot  sponge.  In  these  cases  I  am  in  the  habit  of  directing  the 
nurse  to  apply  the  hot  sponge  to  any  part  that  suffers  pain  or 
uneasiness,  or  wherever  the  eruption  may  not  come  freely  to  the 
surface. 

A  hot  iron  wrapped  in  flannel  and  wetted  with  vinegar  so  as 
to  raise  a  vapor  is  a  still  more  active  application,  and  one  of  the 
most  powerful  stimulants  known.  It  is  claimed  that  a  current 
of  electricity  is  thus  generated,  and  we  faradize  the  surface  as 
well  as  stimulate  it  with  heat. 

The  Hot  Bath. — A  general  hot  bath  may  be  given  in  any  ves- 
sel large  enough  to  hold  the  child.  The  water  should  have  a 
temperature  of  125  degrees  at  least,  and  should  cover  the  entire 
body.  The  child  should  not  remain  too  long  in  it,  and  when 
removed  should  be  wrapped  in  a  warm  blanket  until  thoroughly 
dry.  Common  salt  may  be  added  to  the  water,  when  there  is 
much  debility,  or  a  tendency  to  congestion.  With  care,  such  a 
hot  bath  may  be  used  with  advantage  in  the  early  stage  of  acute 
diseases. 

Inunctions. — There  are  cases  where  fatty  inunctions  answer  a 
better  purpose  than  baths.  The  bath  leaves  the  skin  dry  and 
harsh  and  inactive ;  the  inunction  leaves  it  soft  and  pliable,  and 
in  better  condition  for  functional  activity. 

Sonietimes  we  use  lard  alone,  or,  if  there  is  a  tendency  to 
aplastic  deposits,  cod-liver  oil.  When  there  is  periodicity,  or 
when  we  wish  to  get  the  action  of  quinine  it  is  added  to  the  lard. 
If  we  wish  the  inunction  stimulant,  we  add  one  of  the  essential 
oils  in  small  quantity  (they  are  very  active  when  combined  with 
fatty  matter). 

In  scarlet  fever  we  sometimes  have  the  patient  rubbed  thor- 
oughly with  a  bacon-rind  or  piece  of  fat  bacon.  Or,  we  may 
order  it  from  the  drug  store  as  follows : — I^  Creasote  gtt.  xx.. 
Common  Salt  Sss.,  Lard  Sij-  Ammonia  added  to  the  lard  makes 
a  very  stimulant  application,  and  I  sometimes  order  it  when  the 
skin  is  very  feeble,  or  when  it  is  necessary  to  bring  an  eruption 
to  the  surface,  as — I^  Bicarbonate  of  Ammonia  or  Hydrochlorate 
of  Ammonia  5ss.,  Lard  Sij.     Mix. 

DiLUF.XTS  A  certain  amount  of  fluid  is  necessary  to  the 
proper  performance  of  function,  and   I  am   satisfied   that   many 


92  DISEASES   OF   CHILDREN. 

times  the  sick  suffer  severely  from  the  waut  of  it,  either  because 
the  physician  does  not  think  it  worth  his  while  to  look  after  such 
small  matters,  or  the  condition  of  disease  is  such  that  it  can  not 
be  introduced.  Here  was  one  of  the  evils  of  the  old  practice — 
they  used  remedies  which  were  incompatible  with  water,  or  w  hich 
kept  the  stomach  in  such  condition  that  water  could  not  be  ab- 
sorbed by  the  stomach. 

Warm  Drinks. — An  infusion  of  catnip,  sage,  chamomile,  ascle- 
pias,  and  many  other  simples,  or  even  hot  water,  will  prove 
diaphoretic,  and  is  sometimes  useful  in  slight  ailments.  The 
difficulty  in  their  use  is  the  repugnance  the  child  has  to  anything 
unpleasant,  and  to  the  quantity  necessary  to  be  given  to  get  a 
diaphoretic  influence. 

If  warm  drinks  can  not  be  taken,  or  sometimes  if  they  can, 
we  think  it  better  to  administer  cold.  I  make  it  a  rule  to  ask 
if  my  little  patient  has  expressed  a  desire  for  water,  and  advise 
that  it  be  given  frequently  if  the  child  has  any  thirst.  Some- 
times we  will  find  that  the  little  one  takes  it  eagerly,  and  follow- 
ing its  use  the  irritation  and  restlessness  subside,  and  it  goes  to 
sleep.  Again,  we  will  find  that  the  frequent  giving  of  cold  water 
in  moderate  quantities  lessens  the  temperature  and  the  frequency 
of  the  pulse,  and  the  child  is  better  in  every  respect. 

In  some  cases  the  child  may  have  lemonade  to  good  advantage, 
either  hot  or  cold,  as  it  will  take  it  best.  In  others,  whey  answers 
a  most  excellent  purpose,  and  is  taken  with  pleasure. 

When  the  temperature  is  high,  and  fluids  can  not  be  taken  by 
mouth,  I  think  it  well,  in  some  cases,  to  use  it  by  enema.  Four 
ounces  of  cold  water  thrown  up  the  rectum  will  lower  the  tem- 
perature of  the  entire  body  two  or  three  degrees.  If  there  is 
continued  nausea  a  very  small  portion  of  common  salt  may  be 
added  to  the  fluid  used  in  this  way. 

AscLEPiAS.  Specific  Indications. — The  pulse  is  strong,  the 
patient  has  sharp  pain  in  some  part,  inflammation  of  serous  mem- 
branes, skin  hot  and  dry  but  not  constricted,  urine  scanty,  pain- 
ful cough. 

Dose. — Ki  Tinct.  Asclepias  gtt  x.,  water  5iv. ;  a  teaspoonful 
every  hour. 

Asclepias  may  be  taken  as  the  type  of  a  diaphoretic,  acting 
kindly,  and  promoting  that  normal  activity,  "  insensible  perspira- 
tion."    The  skin  softens,  the  temperature  comes  down,  the  pulse 


INFANTILE   THERAPEUTICS.  93 

is  less  frequent,  and  the  nervous  system  is  relieved.  It  is  especi- 
ally a  good  remedy  in  pleuritis  or  pleuro-pneumonia,  and  iu 
rheumatism  involving  synovial  membranes. 

EuPATORiUM  Perf.  The  Boneset  has  a  direct  influence  upon 
the  skin,  and  may  be  employed  to  good  advantage  when  the 
pulse  is  full  and  strong,  and  the  skin  gives  the  sensation  that 
perspiration  is  almost  ready  to  break  out.  It  may  be  employed 
alone  or  in  combination  with  the  sedatives. 

Crocus  Sativus.  Specific  Indications. — The  skin  is  dull, 
mottled  and  inactive,  afterwards  becomes  exceedingly  dry  and 
harsh  with  irritation  of  mucous  membranes.  An  eruption  shows 
itself  beneath  the  skin,  or  there  has  been  a  retrocession. 

Dose. — Saffron  may  be  used  in  infusion,  or  the  tincture  may  be 
given  with  warm  water. 

True  saffron  is  one  of  the  most  certain,  as  it  is  one  of  the 
kindliest  of  diaphoretics,  and  when  it  can  be  obtained  it  should 
be  employed,  especially  in  the  eruptive  fevers.  It  will  be  found 
very  much  better  than  the  old  remedies,  which  irritate  the 
stomach  and  bowels. 

Nepeta  Cataria.  Specific  Indications. — The  skin  is  dry  and 
harsh,  mucous  membranes  of  the  air  passages  irritable,  urine 
scanty,  more  or  less  pain  in  abdomen. 

Dose. — Catnip  may  be  given  in  sweetened  infusion  in  irritation 
of  the  respiratory  and  intestinal  mucous  membranes,  or  the 
tincture  may  be  added  to  water  in  the  proportion  of  gtt.  x.  to 
gtt.  XX.  in  water  5iv.,  and  given  in  teaspoonful  doses. 

It  must  not  be  supposed  that  because  catnip  is  such  a  common 
domestic  remedy,  it  is  worthless,  for  it  will  sometimes  answer  a 
better  purpose  than  the  stronger  and  harsher  medicines.  Used 
with  the  sedatives  it  gives  excellent  results  in  fevers  complicated 
with  irritation  of  mucous  membranes. 

Serpentaria.  Specific  Indications. — The  skin  is  inactive, 
harsh,  desquamation  of  epidermis,  epidermis  feels  rough  and 
dead,  weight  and  dragging  in  the  loins,  scanty  urine,  fullness  of 
chest,  difficult  respiration. 

Dose. — I^  Tinct.  Serpentaria  gtt.  v.  to  gtt.  x.,  water  Siv. ;  a 
teaspoonful  every  one  to  three  hours. 


94  DISEASES  OP  CHILDREN. 

Belladonna.  Though  a  remedy  which  is  studied  with 
especial  reference  to  the  nervous  system,  it  also  influences  the  skin 
directly,  and  is  thus  one  of  our  most  important  remedies.  The 
reader  will  remember  the  statement  that  "  it  causes  contraction 
of  capillary  blood-vessels,  and  thus  overcomes  congestion."  This 
is  its  most  important  action,  and  this  it  does  in  the  skin  and 
kidneys  as  well  as  in  the  brain. 

Congestion  of  the  skin  is  known  by  the  deep  coloration,  dusky 
red,  or  when  bright  red,  and  the  redness  is  effaced  by  pressure,  a 
persistent  white  line  is  left.  In  the  eruptive  fevers  its  influence 
is  to  bring  the  eruption  to  the  surface.  This  is  shown  in  the 
simpler  eruptions,  erythema  and  urticaria,  and  in  the  severer 
eruptive  fever — scarlatina. 

Dullness  of  mind  and  disposition  to  sleep  are  almost  always 
associated  with  congestion  of  the  skin,  but  in  some  cases  there 
will  be  marked  impairment  of  the  capillary  circulation  of  the 
skin  before  the  brain  suffers. 

Rhus.  This  remedy  exerts  a  direct  influence  upon  the  skin, 
being  Indicated  by  bright  redness  and  burning  pain.  It  is  a  rem- 
edy in  hives,  with  burning  and  itching ;  in  scarlet  fever  when  the 
skin  is  hot,  dry  and  burning;  in  erysipelas  where  there  is  vivid 
redness  with  burning  pain. 

Of  course  we  are  not  altogether  guided  by  symptoms  from  the 
skin,  though  these  would  be  sufficient.  The  sharp  stroke  of 
pulse,  frontal  headache,  and  prominent  red  papillae  on  tip  of 
tongue  will  be  additional  indications. 

Apis.  Apis  is  indicated  by  itching  of  the  skin  or  outlets  of 
the  body.  It  is  a  most  valuable  remedy  when  thus  indicated,  as 
in  "  heat,"  hives,  scarlet  fever,  prurigo,  erysipelas  and  some  cases 
of  eczema. 

Senega.  Senega  is  a  stimulant  to  the  skin,  and  may  be  em- 
ployed where  there  is  a  feeble  circulation,  coldness  of  the  ext?rem- 
ities,  and  dry,  harsh,  dead  epidermis. 

Sulphur.  This  remedy,  which  is  fully  studied  under  the  head 
of  restoratives,  exerts  a  direct  influence  upon  the  skin,  improving 
its  nutrition  and  functional  activity.  Dryness  and  separation  of 
the  epidermis,  vesicular  or  pustular  disease,  or  change  of  color 
will  indicate  it.  It  has  been  used  both  locally  and  as  an  internal 
remedy,  and  in  both  ways  proves  beneficial. 


INFANTILE    THERAPEUTICS.  95 

Arsenic.  Specific  Indications. — Inactive  skin,  wants  elas- 
ticity; dull,  sallow,  or  pallid  color ;  eczematous  eruption ;  feeble 
circulation ;  periodicity  not  cured  by  quinine. 

Dose. — For  children,  in  ordinary  cases,  I  prefer  a  second  or 
third  decimal  dilution,  though  I  sometimes  use  the  pellets  wetted 
with  Fowler's  Solution,  or  with  a  first  Homceopathic  dilution. 
In  skin  disease  where  a  stronger  action  is  wanted  we  prescribe — 
I^i  Fowler's  Solution  gtt.  v.  to  gtt.  x.,  water  giv. ;  a  teaspoonful 
every'four  hours,  or  three  times  a  day. 

Homoeopathic  Indications  (3d  to  6th  decimal). — Great  restless- 
ness and  anxiety  with  burning  pains,  violent  thirst  with  frequent 
drinking  of  but  little  water  at  a  time ;  vomiting  and  diarrhoea, 
stools  watery,  offensive,  and  undigested,  dysenteric  stools ;  patient 
wants  to  be  in  a  warm  room,  or  warmly  covered ;  attacks  of 
anguish,  with  fear  of  death  ;  face  pale  and  haggard,  great  exhaus- 
tion ;  suppression  of  the  urine  or  bloody  urine ;  oppressed  breath- 
ing, oedema  of  the  eyelids,  urticaria,  eczema,  pityriasis,  falling 
out  of  the  hair,  trembling,  stiffness  and  contraction  of  the  joints; 
aggravation  of  symptoms  after  midnight,  on  lying  down  with  the 
head  low,  and  in  the  cold  air. — Ehrmann. 

ANTI-ZYMOTICS. 

We  have  been  in  the  habit  of  classifying  such  remedies  as 
oppose  the  putrefactive  process  in  blood  as  anti-septics,  but  it  is 
better  perhaps  to  study  them  as  antizymotics.  Zymosis  is  more 
like  a  process  of  fermentation ;  as  Dr.  Dunglison  defines  it,  it  is 
"  any  epidemic,  endemic,  contagious,  or  sporadic  affection,  which 
is  produced  by  some  morbific  principle  acting  on  the  organism 
similar  to  a  ferment — as  the  major  exanthemata." 

The  symptoms  of  zymosis  are  prostration  and  impairment  of 
life,  and  those  that  are  usually  designated  as  typhoid.  The  tongue 
is  dirty,  or  the  coatings  are  brown  or  deep  colored ;  in  the  first 
case  the  tongue  is  moist,  and  in  the  second  it  is  inclined  to  be 
dry.  In  both  cases  sordes  accumulate  around  teeth  and  gums, 
and  the  discharges  from  the  body  become  peculiarly  offensive. 

The  causes  of  zymosis  it  is  claimed,  act  similarly  to  if  not  as 
ferments,  setting  up  in  any  fluids  of  the  body  septic  processes 
which  ]>roduce  material  like  the  original.  Thus  the  poison  of 
tvphoid  fever  introduced  into  the  body  will  grow  a  condition  of 
disease  like  the  original,  and  will  generate  a  poison  similar  to 


96  DISEASES  OF    CHILDREN. 

that  introduced.  We  notice  the  same  in  erysipelas,  in  zymotic 
dysentery,  in  diphtheria,  and  in  other  diseases. 

An  anti-zymotic  is  a  remedy,  therefore,  which,  introduced  into 
the  body  (blood),  will  antagonize  such  ferment,  and  arrest  the 
j)rocess  that  is  going  on  to  the  destruction  of  life.  In  the  case 
of  some  of  these  remedies,  we  can  see  how  they  act,  for  they  will 
stop  the  process  of  fermentation  outside  of  the  body  as  well  as 
within.  But  in  others,  we  can  not  tell  how  this  is  accomplished, 
because  the  remedy  has  no  chemical  action,  and  is  used  in^  very 
minute  doses.  But  whether  we  can  account  for  this  action  or  not, 
if  experience  proves  that  definite  results  follow  the  administration 
of  a  remedy,  we  should  be  satisfied  to  give  it  when  indicated. 

It  will  also  be  noticed  that  we  have  a  group  of  these  remedies, 
all  antidoting  the  process  of  zymosis,  yet  each  having  an  indi- 
vidual action,  and  not  being  interchangeable  one  for  the  other. 
Indeed,  they  are  so  different  in  their  construction  that  we  would 
hardly  expect  them  to  act  in  a  similar  manner.  As  we  can  not 
interchange  them,  and  must  have  the  right  remedy,  if  we  wish 
good  results,  we  will  be  especially  careful  in  examining  the 
symptoms  that  point  to  the  remedy. 

The  remedies  we  will  study  under  this  head  are  : — 

Acids,  Sulphurous  Acid,  Hydrochloric  Acid, 

Baptisia,  Sulphate  of  Soda,  Chlorate  of  Potash. 

Phytolacca. 

Acids.  We  have  studied  these  under  the  head  of  remedies 
that  influence  the  respiratory  function,  to  which  the  reader  is 
referred,  but  it  is  well  to  examine  them  in  this  relation.  The 
indications  for  their  use  is,  a  deep-red  color  of  tongue  and  mucous 
membranes,  the  tongue  being  usually  dry  and  contracted,  coated 
brown,  or  slick  and  like  raw  beef;  deep  redness  of  parts,  when 
blood  comes  freely  to  the  surface,  may  also  be  noted. 

As  muriatic  acid  is  studied  separately  we  will  notice  here  that 
acetic  and  lactic  acids  will  sometimes  fulfill  the  indication.  We 
give  the  first  in  the  form  of  a  good  sharp  cider,  which  is  also  a 
mild  stimulant;  and  the  second  as  whey,  formed  by  curdling 
milk.  Both  of  these  will  be  taken  kindly  by  children,  when 
muriatic  acid  would  be  refused. 

Hydrocht>otitc  Acid.  Specific  Indications. — The  tonrrue  is 
dry  and  contracted,  and  the  color  deep-red  or  dusky-red.     Coat- 


INFANTILE  THERAPEUTICS.  97 

ings  of  tongue  are  inclined  to  be  brown,  growing  darker  as  the 
disease  advances,  and  there  is  dark  sordes  about  the  teeth. 

Dose. — It  is  added  to  water  so  as  to  make  a  pleasant  drink,  a 
little  syrup  being  added,  and  given  ad  libitum. 

Homoeopathic  Indications  (3d  to  6th  decimal). — In  typhoid 
fever,  when  the  patient  has  a  tendency  to  slide  down  towards  the 
foot  of  the  bed;  great  debility;  diarrhoea  with  great  itching  and 
soreness  of  the  anus ;  hemorrhoids  excessively  painful  to  the 
touch,  bleeding  profusely ;  involving  discharges  of  feces  while 
urinating;  sad  and  silent  during  the  menses;  early  and  profuse 
menstruation ;  scarlet  fever,  rash  intensely  red  with  great  dizzi- 
ness; sore  throat,  foul  breath,  acrid  discharge  from  the  nose. — 
Ehrmann. 

With  the  indications  named  no  remedy  will  give  better  satis- 
faction than  this  acid.  In  some  cases  it  seems  to  do  everything 
that  is  necessary  in  the  case.  It  lessens  the  frequency  of  the 
pulse,  brings  the  temperature  down,  relieves  irritation  of  the 
nerve  centers,  places  the  stomach  in  better  condition  for  the 
reception  and  digestion  of  food,  softens  the  skin,  and  aids  secre- 
tion. It  makes  no  difference  where  or  what  the  disease  is,  if  the 
remedy  is  indicated  it  proves  beneficial. 

Sulphurous  Acid.  Specific  Indications. — The  tongue  is  of 
normal  redness  and  moist,  but  dirty,  the  coating  is  pasty  and 
sometimes  looks  like  fecal  matter,  the  tongue  is  dull  and  atonic 
and  has  no  papillae,  the  fauces  and  phaynx  full  and  relaxed,  and 
the  mucoid  secretion  brownish  and  dirty,  moist  sordes  about  the 
teeth,  fetid  breath. 

Dose. — This  is  a  feeble  acid  and  may  be  given  in  doses  of  gtt. 
V.  to  gtt.  XX.,  and  the  following  prescription  will  be  very  gpod 
for  children  from  two  to  five  years:  ^  Sulphurous  Acid  Sjv 
water  .5iij-  ;  a  teaspoonful  every  three  hours. 

Sulphurous  acid  is  a  valuable  remedy  in  diphtheria,  cynanche 
maligna,  malignant  scarlet  fever,  in  some  cases  of  small  pox,  and 
indeed  in  any  contagious  or  zymotic  disease  where  the  above  in- 
dications are  found.  It  is  not  only  a  good  remedy  when  admin- 
istered internally,  but  it  is  also  an  excellent  local  application  in 
diphtheria  and  cynanche,  and  where  a  part  shows  a  tendency  to 
brake  down. 

7 


98  DISEASES   OF   CHILDREN. 

Sulphite  of  Soda.  Specific  Indications. — The  tongue  is 
broad  and  pallid,  the  coating  pasty,  white  and  dirty,  frequently 
the  breath  is  fetid. 

Dose. — The  dose  for  a  child  will  be  from  one  to  five  grains,  ac- 
cording to  age,  repeated  every  three  hours. 

If  one  will  test  the  sulphite  of  soda  when  indicated  as  above, 
he  will  become  a  convert  to  specific  medication.  It  acts  kindly 
and  directly,  not  only  in  controlling  zymosis,  but  on  the  circula- 
tion, temperature,  nervous  system,  and  in  establishing  excretion. 
It  is  a  fair  example  of  the  therapeutic  maxim,  "when  a  remedy 
is  indicated  by  a  special  symptom  or  symptoms,  it  proves  curative 
in  any  form  of  disease." 

Chlorate  of  Potash.  Specific  Indications. — Fetid  odor,  as 
from  cynanche  maligna,  fetid  lochial  discharge,  as  from  decom- 
posing animal  matter.  As  a  local  application  it  is  indicated  by 
bright  redness  of  parts. 

Dose. — For  internal  administration  to  children  the  dose  will 
vary  from  one-eighth  of  a  grain  to  one  grain ;  as  a  local  applica- 
tion a  solution  of  grs.  x.  to  grs.  xx.,  in  water  Siv. 

Chlorate  of  Potash  has  been  so  extensively  used  that  there  is 
less  need  of  recommending  it  to  readers,  than  of  caution  against 
its  abuse.  When  indicated  it  is  a  most  excellent  remedy,  none 
better ;  but  when  not  indicated,  especially  when  tissues  are  dull 
and  dusky  in  color,  and  the  patient  has  a  feeble  circulation,  it  may 
do  serious  damage. 

It  should  be  used  with  great  care  in  the  eruptive  fevers,  or 
when  there  is  irritation  of  the  kidneys,  for  it  will  sometimes  im- 
pair the  functions  of  these  organs  to  such  an  extent  that  the 
patient  will  suffer,  or  may  die  from  uraemia. 

Baptisia.  Specific  Indications. — The  face  is  full  and  purplish, 
like  one  who  has  been  exposed  to  severe  cold;  the  tongue  and 
mucous  membrane  of  fauces  and  throat  are  full,  and  bear  the 
same  purplish  or  leaden  discoloration. 

Dose. — ^  Tinct.  Baptisia  gtt.  x.,  water  Siv. ;  a  teaspoonful 
every  hour. 

Homosopathic  Indications  (3d  to  6th  decimal). — Typhoid  symp- 
toms, dull  headache,  soreness  as  if  in  the  brain,  sleeplessness,  can 
not  go  to  sleep  because  "  she  can  not  get  herself  together ;"  great 
dryness  of  the  mouth  and  tongue,  tongue  coated,  dry  and  brown ; 


INFANTILE  THERAPEUTICS.  99 

putrid,  offensive  breath,  veiy  fetid  stools,  preceded  by  colicky 
pains  in  the  hypogastrium. — Ehrmann. 

The  symptoms  indicating  this  remedy  are  so  clear  that  one  can 
hardly  go  astray.  The  first  sight  of  the  person  is  frequently 
sufficient — the  full,  discolored  face,  like  one  that  has  been  long 
exposed  to  cold — if  not  the  bluish  or  purplish  coloration  of 
tongue  and  mucous  membranes,  is  sufficient.  It  exerts  an  ad- 
mirable influence  in  typhoid  disease,  whether  fever  or  inflamma- 
tion, in  some  cases  of  diphtheria  and  cynanche,  and  in  zymotic 
dysentery.  When  the  indications  are  strong  it  will  sometimes 
do  everything  that  one  could  expect  of  medicine — lessening  the 
frequency  of  the  pulse,  reducing  the  temperature,  relieving  the 
nervous  system,  putting  the  stomach  in  good  condition  for  the 
reception  of  food,  and  establishing  secretion  and  excretion. 

Phytolacca.  Specific  Indications. — There  is  sore  mouth ; 
small  blisters  raise  on  the  tongue,  mucous  membrane  of  the 
mouth  and  fauces ;  apthse ;  sore  throat ;  diptheritic  exudation ; 
soreness  and  rawness  of  the  mucous  membrane  of  the  nose;  sore 
lips,  they  look  blanched,  and  the  epidermis  separates ;  enlarge- 
ment of  parotid  and  submaxillary  glands  ;  the  cervial  lymphatics 
are  enlarged;  disease  of  the  breasts;  orchitis. 

Dose. — 'B^  Tinct.  Phytolacca  (fresh  root)  gtt.  v.  to  gtt.  x., 
water  5iv. ;  a  teaspoonful  every  one  to  three  hours. 

Homoeopathic  Indications,  (3d  to  6th  decimal). — Syphilitic  and 
mercurial  rheumatism  ;  nightly  pains  in  the  tibia,  with  nodes  and 
irritable  ulcers  on  the  leg ;  sensation  of  roughness  and  rawness 
in  the  throat ;  feeling  of  a  lump  in  the  throat,  causing  a  continu- 
ous desire  to  swallow;  deep  ulcers  on  the  tonsils  or  base  of  the 
tongue;  very  offensive  odor,  and  great  pain  on  swallowing; 
habitual  constipation,  feeling  of  fullness  in  abdomen  before  stool ; 
capacious  flow  of  urine;  albuminous  urine;  inflammation,  swell- 
ing and  suppuration  of  the  mammae. — Ehrmann. 

Phytolacca  is  one  of  the  most  certain  remedies  in  the  materia 
medica,  meeting  the  most  grave  forms  of  disease.  It  is  indicated 
in  a  large  number  of  cases  of  diphtheria,  and  seems  to  antidote 
the  zymotic  cause,  and  in  some  seasons  will  cure  nearly  every 
case.  It  is  also  the  remedy  for  parotitis,  or  mumps.  We  pre- 
scribe it  for  infantile  sore  mouth  with  most  excellent  results,  as 
we  do  for  the  sore  nipples  of  the  mother  which  are  associated 
with  it.  It  has  a  very  favorable  action  in  scrofula  when  it 
manifests  itself  in  the  cervical  lymphatics. 


100  DISEASES  OF  CHILDREN. 

ANTISEPTICS. 

We  will  embrace  in  this  group  those  agents  which  destroy 
septic  poisons,  and  arrest  the  processes  of  sepsis  outside  of  the 
body.  The  classification  may  not  be  the  best,  but  I  hope  it  will 
not  create  confusion.  The  anti-zymotics  are  really  antiseptics, 
though  as  we  are  in  the  habit  of  studying  a  group  of  diseases  as 
produced  by  zymotic  poisons,  and  their  influence  upon  the  body 
as  zymosis,  it  is  quite  as  well  to  think  of  the  internal  remedies 
which  meet  this  as  anti-zymotics. 

In  medicine,  cleanliness  takes  precedence  of  godliness,  and 
many  times  the  need  of  antiseptics  may  be  prevented  by  strict 
attention  to  cleanliness.  There  is  an  intimate  relation  between 
"  dirt  and  disease,"  especially  if  the  dirt  is  the  waste  of  the  human 
body,  or  that  which  it  subsists  upon.  Soap  and  water  will  stand 
first  in  the  list  of  antiseptics. 

Good  air  is  a  requisite  of  good  life,  and  many  germs  of  disease 
overtake  people  and  gain  entrance  to  their  bodies  through  bad 
air.  The  air  is  defiled  in  many  ways,  and  all  these  should  be 
thought  of  and  avoided.  The  sick  should  have  their  supply  from 
such  sources  as  will  give  it  as  pure  as  possible.  Whilst  air  is 
admitted  to  the  room,  from  without,  provision  should  be  made 
for  the  egress  of  the  air  that  Ijas  been  used.  An  open  fire-place 
with  a  fire  is  the  best  means  of  ventilation  in  ordinary  houses ; 
if  stoves  must  be  used,  they  should  have  the  doors  open  so  as  to 
permit  a  draught. 

Fecal  matter  is  especially  poisonous  in  zymotic  disease,  and 
should  be  removed  from  the  room  at  once,  and  the  vessels 
thoroughly  cleansed  and  possibly  disinfected.  When  removed, 
care  should  be  taken  that  it  is  not  emptied  where  it  will  defile 
the  water  supply,  either  by  running  into  the  well,  or  into  some 
stream  which  supplies  other  persons. 

We  will  study  the  following  antiseptics  : — 

Thymol,  Sulphate  of  Iron,  Chloride  of  Lime, 

Carbolic  Acid,  Sulphurous  Acid,  Chloride  of  Lead, 

Permanganate  of  Potash,         Liquor  Sodae  Chlorinatae. 

Thymol.  Thymol,  in  weak  solution  in  alcohol  and  water,  is 
used  as  an  antiseptic  dressing  to  wounds  and  in  surgical  opera- 
tions, or  to  abscesses  when  they  are  discharging.  Thymol  may 
also  be  used  to  disinfect  the  chamber  utensils,  and  dressings  for 
wounds.     In   some   cases  the  object  is  to  prevent  infection  by 


INFANTILE  THERAPEUTICS.  101 

septic  germs,  in  others  it  is  to  arrest  putrescence  in  a  feeble  part. 
It  may  be  used  of  the  strength  of — ^i  Thymol  gr.  ij.  to  gr.  iv., 
alcohol  §ss.,  Avater  Siijss. 

Carbolic  Acid.  Carbolic  acid  may  sometimes  be  used  with 
advantage  to  arrest  the  process  of  sepsis  in  injuries  and  surgical 
operations,  and  as  an  excitant  to  feeble  parts.  Usually  we  pre- 
scribe— ^  Carbolic  Acid  5j.,  Glycerine  Sj.,  water  5 v.  Mix.  In 
this  strength  Carbolic  Acid  is  an  excellent  dressing  for  burns 
and  scalds. 

We  employ  this  acid  in  full  strength  to  destroy  warts,  working 
it  down  to  the  base  of  the  growth  with  a  pine  pencil.  It  causes 
suppuration,  and  in  this  the  growth  is  permanently  removed. 

Sulphate  of  Iron.  Sulphate  of  Iron  in  solution  is  a  fair 
disinfectant  for  privies,  drains,  water  closets,  chamber  utensils, 
etc.,  though  it  is  not  as  good  as  the  other  named. 

Sulphurous  Acid.  This  remedy,  studied  with  the  anti- 
zymotics,  is  also  a  most  excellent  antiseptic ;  bowels  may  be 
cleared  with  it,  a  diseased  surface  sponged  with  it,  dressing 
thoroughly  disinfected  with  it,  and  finally,  if  used  with  a  spray 
apparatus,  the  air  may  be  disinfected. 

The  old  method  of  burning  sulphur  in  a  room  answers  an  ex- 
cellent purpose.  It  is  easily  done  by  holding  a  pan,  containing 
the  sulphur,  over  the  chimney  of  a  coal  oil  lamp.  In  the  olden 
time  they  sprinkled  the  sublimed  sulphur  over  a  pan  of  live 
coals.  In  cases  of  very  severe  small-pox  I  have  seen  the  air  so 
freshened  by  burning  sulphur  that  the  patient  was  improved 
within  an  hour. 

Chloride  of  Lime.  I  like  the  old  antiseptic.  Chloride  of 
Lime,  quite  as  well  as  any  for  the  disinfection  of  water  closets, 
drains,  sewers  and  privies,  and  sometimes  to  purify  the  air  of 
rooms.  This  agent  should  be  fresh,  and  as  they  now  put  it  up 
in  pound  and  half  pound  cans,  it  can  be  procured  and  used  of  full 
strength.  For  use  in  the  house  it  may  be  placed  in  a  saucer  and 
sprinkled  with  vinegar. 

Liquor  Sod^  Chlorinate.  The  officinal  solution  of  chlo- 
rinated soda  is  a  valuable  disinfectant  and  antiseptic.  It  is 
especially  useful  to  cleanse  vessels,  surgical  dressings  and  band- 
ages, water  closets,  drains  and  sewers;  used  with  an  atomizer  or 


102  DISEASES  OF  CHILDREN. 

spray  apparatus  it  will  purify  the  air  of  a  room  and  destroy  dis- 
ease germs.  In  severe  diphtheria,  in  scarlatina  maligna,  and 
small-pox,  its  frequent  use  is  of  advantage  to  the  patient,  and 
prevents  the  spread  of  the  contagion. 

Chloride  of  Lead.  Take  of  Nitrate  of  Lead  half  a  drachm, 
dissolve  it  in  a  pint  of  boiling  water;  disolve  two  drachms  of 
common  salt  in  a  bucket  of  water,  and  pour  the  two  solutions 
together.  The  clear,  supernatent  fluid  will  be  a  saturated  solu- 
tion of  chloride  of  lead.  "  A  cloth  dipped  in  this  solution  and 
hung  up  in  a  room  will  sweeten  a  fetid  atmosphere  instantane- 
ously ;  or  the  solution  thrown  down  a  sink  or  water  closet  or 
drain,  or  over  a  heap  of  refuse,  will  produce  a  like  result."  It 
is  a  cheap  disinfectant  and  antiseptic,  and  may  be  used  freely  at 
but  little  expense. 

Permanganate  of  Potash.  "We  rarely  employ  the  perman- 
ganates internally  on  account  of  their  irritant  action  upon  the 
stomach.  But  as  a  local  application  to  arrest  the  septic  process, 
and  to  prevent  rapid  destruction  of  tissue,  it  has  no  superior.  It 
is  used  in  superficial  and  phlegmonous  erysipelas,  suppurative 
skin  diseases,  in  the  treatment  of  superficial  inflammations  when 
parts  manifest  debility,  in  the  treatment  of  abscesses,  and  other 
suppurations  the  result  of  inflammation,  and  the  treatment  of 
wounds  and  injuries.  The  solution  for  external  use  will  be  made 
in  the  proportion  of  from  one-half  to  one  drachm  of  the  salt  to 
one  pint  of  water.  When  the  tissues  are  greatly  debilitated  it 
may  be  used  as  strong  as  ten  grains  to  the  ounce  of  water. 

ANTI- rheumatics. 

"We  have  a  peculiar  inflammatory  process  which  we  call  rheu- 
matic, and  a  variety  of  pain  which  we  also  call  rheumatic,  and 
both  of  these  are  due  to  a  special  cause.  Not  only  have  we 
rheumatic  inflammation  and  rheumatic  pain,  but  we  frequently 
find  the  rheura^ic  cause  influencing  other  diseases.  "What  this 
cause  is,  is  not  accurately  known.  It  has  been  thought  to  be 
lactic  acid  generated  during  retrograde  metamorphosis,  or  by 
decomposition  or  mal-digestion  of  food.  Whether  lactic  acid  or 
not,  it  is  certainly  a  product  of  retrograde  metamorphosis  or 
food  decomposition,  and  may  be  acid  in  one  case,  an  ammonia 
product  in  another,  and  neutral  in  another.  Whatever  it  is,  how- 
ever, it  is  specific  in  its  nature,  a^ul  is  met  by  specific  remedies. 


INFANTILE  THERAPEUTICS.  103 

We  might  have  studied  this  group  of  remedies  under  the  head 
of  "rheumatism/'  but  I  think  it  will  serve  our  purpose  better  to 
examine  them  here,  especially  because  we  employ  them  in  dis- 
eases that  would  not  be  called  rheumatic.  Then  again,  these 
remedies  have  other  actions  that  are  important,  and  we  can  see 
them  all  to  better  advantage. 

The  group  of  anti-rheumatics  will  be  as  follows : — 


Macrotys, 

Sticta, 

Salicylic  Acid, 

Bryonia, 

Apocynum, 

Alkalies. 

Phytolacca, 

A-cids, 

Macrotys.  .  Specific  Indications. — Muscular  pain,  pain  is  in- 
termittent, as  if  due  to  muscular  contraction,  parts  swollen  tense, 
pain  somewhat  throbbing  (no  evidence  of  suppuration),  pains  in 
inguinal  region  and  groins,  lumbar  pains. 

Dose. — 1|«  Tinct.  Macrotys  gtt.  v.,  water  giv. ;  a  teaspoonful 
every  one  to  three  hours. 

With  the  indications  as  above  named  Macrotys  is  a  very  cer- 
tain anti-rheumatic.  As  there  is  fever  and  inflammation,  we 
usually  associate  it  with  the  Veratrum.  In  some  seasons  it  seems 
to  be  indicated  in  almost  every  case  of  rheumatism  or  rheumatic 
pain,  so  that  we  are  inclined  to  think  that  it  will  cure  every  case, 
and  possibly  the  next  year  the  disease  has  so  changed  that  it  will 
relieve  none. 

Bryonia.  This  remedy  has  been  fully  studied,  and  we  notice 
it  here  only  as  it  influences  rheumatism.  The  indications  are 
sharp  pain,  the  serous  membranes  are  involved,  the  pain  is  ten- 
sive, the  pulse  is  full  and  hard,  and  the  patient  inclined  to  cough. 

Apocynum.  Apocynum  was  studied  under  the  head  of  reme- 
dies which  influence  the  circulation.  The  indications  for  it  in 
rheumatism  and  rheumatic  pains  are — cedema  of  feet,  eyelids  or 
other  part,  and  puffiness  or  cedema  of  part  affected. 

Salicylic  Acid.  Specific  Indications. —  The  tongue  is  full, 
leaden -colored  or  purplish,  the  temperature  high,  but  without 
dryness  of  the  skin  ;  the  breath  is  sometimes  fetid ;  the  tongue  is 
broad  with  leaden  pallor. 

Dose. — The  best  form  to  administer  Salicylic  Acid  to  children 
is  as  a  Salicylate  of  Potash,  say — ^  Salicylic  Acid  gr.  x.  to  grs. 
XX.,  Acetate  of  Potash  5ss.,   water  5iv.  ;  dose  half  teaspoonful 


104  DISEASES  OF  CHILDREN. 

to  one  teaspoonful  every  two  or  three  hours.  As  a  local  appHca- 
tian  it  may  be  solved  with  Borax  or  Chlorate  of  Potash,  the 
first  being  the  best  antiseptic,  as — ^  Salicylic  Acid  grs.  v.  to 
grs.  X.,  Borax  or  Chlorate  of  Potash  grs.  x.,  water  giv. 

Where  the  case  is  properly  selected  Salicylic  Acid  lowers  the 
temperature,  controls  the  circulation,  and  the  specific  gravity  of 
the  urine  is  markedly  increased.  But  when  not  indicated  it 
irritates  the  nervous  system.  As  a  local  application  we  employ 
it  in  the  treatment  of  nasal  catarrh,  and  in  diseases  of  the  throat 
with  muco-purulent  secretion.  It  is  a  good  local  remedy  in  some 
cases  of  cynanche  maligna,  malignant  scarlatina  and  diphtheria. 
In  these  cases  it  is  used  with  a  spray  apparatus.  With  Borax  it 
may  be  used  as  a  dressing  to  wounds  and  superficial  inflamma- 
tions, if  the  parts  are  relaxed  and  atonic. 

Phytolacca.  This  remedy,  studied  under  the  head  of  anti- 
zymotics  is  also  an  anti-rheumatic,  if  the  indications  for  it  are 
present :  Pale  tongue,  sore  mouth,  vesicular  eruption  on  tongue 
and  about  the  mouth,  enlargement  of  lymphatic  glands. 

Sticta.  Sticta  Pulmonaria,  studied  under  the  head  of  remedies 
that  influence  the  respiratory  apparatus,  is  a  most  excellent  anti- 
rheumatic if  the  following  symptoms  present :  The  neck  is 
stiff  and  painful,  the  head  drawn  back  or  to  one  side,  pain  in 
shoulders  extending  to  neck  and  occiput. 

Acids.  If  one  has  read  the  medical  journals  of  the  past 
twenty-five  years,  he  will  be  surprised  at  what  seems  to  be  a 
fashion  in  the  selection  of  remedies.  For  months,  the  medical 
journals  will  teem  with  articles  in  favor  of  acids  in  the  treatment 
of  rheumatism,  and  reports  of  cures ;  and  then  it  all  seems  to 
change,  and  alkaline  salts  are  just  as  strongly  recommended,  and 
quite  as  many  cases  reported.  It  is  all  rheumatism,  and  nothing 
is  said  about  a  difference  of  cases,  and  we  might  suppose  it  was 
all  chance.  Yet  the  cases  cured  by  acids  could  not  be  reached 
by  alkalies,  and  vice  versa. 

We  have  no  doubt  of  the  cures  in  both  cases,  for  it  is  a  fact 
that  acids  will  relieve  rheumatism,  as  it  is  equally  the  fact  that 
the  cause  of  rheumatism  may  be  antagonized  by  alkalies.  But 
these  are  not  the  same  conditions  of  disease. 

Lemon  juice  is  anti-rheumatic  when  the  tongue  is  markedly  red, 


INFANTILE  THERAPEUTICS.  105 

and  the  papillse  prominent ;  the  coating  of  the  tongue  is  usually 
thin  aud  white. 

Alkaline  Salts.  If  the  tongue  is  broad  and  pallid,  we  use 
an  alkaline  salt,  and  sometimes  it  is  all  that  we  require  to  cure 
any  rheumatism.  It  is  usually  bicarbonate  of  soda  to  the  ex- 
tent of  one-half  to  one  drachm  daily  for  children  two  years  old. 
If  the  tongue  has  a  leaden  pallor,  nitrate  or  acetate  of  potash 
are  the  better  remedies. 

antiperiodics. 

If  physicians  will  not  concede  anything  else,  they  Avill  con- 
cede that  the  group  of  remedies  called  antiperiodic,  and  quiuine 
especially,  has  specific  action.  They  will  go  further,  when 
pressed,  and  admit  a  well  defined  and  positive  indication  for  this 
group  of  remedies.  Pushed  a  little  further,  and  they  will  admit 
the  certainty  of  its  action  when  thus  clearly  indicated. 

This  is  what  we  claim  with  reference  to  all  remedies  which, 
have  been  carefully  studied,  aud  Ave  believe  that  any  one  may 
satisfy  himself  that  we  live  in  a  world  of  law,  medically  as  well 
as  physically,  the  same  causes  always  producing  the  same  effects. 

The  indication  for  the  antiperiodics — periodicity  of  disease — is 
so  clearly  defined  in  many  cases,  that  he  who  runs  may  read. 
There  are  exacerbations  of  the  disease,  whatever  it  may  be,  and 
there  are  remissions  or .  intermissions  in  it.  The  most  common 
type  of  periodic  disease  is  intermittent  fever  or  ague,  a  chill  or 
cold  stage,  a  hot  stage,  a  sweating  stage,  and  period  of  intermis- 
sion. There  is  usually  regularity  in  the  recurrence  of  them,  so 
that  the  disease  having  made  one  "  revolution,"  the  time  of  each 
may  be  predicted. 

It  would  be  interesting  and  profitable  to  know  the  cause  of 
periodic  disease — the  malarial  poison — not  that  it  would  enable 
us  to  treat  it  better,  but  that  we  might  the  better  avoid  it,  or 
possibly  remove  it.  But  in  so  far  as  the  administration  of  reme- 
dies is  concerned,  the  essential  thing  is  to  determine  periodicity 
as  the  basis  of  diseased  action. 

AVhilst  physicians  will  admit  the  positive  action  of  antiperiodics 
in  malarial  disease,  and  claim  that  they  are  as  nearly  "  specifics" 
as  anything  we  have  in  the  materia  medica,  they  will  yet  confess 
to  a  great  many  failures.  These  failures  prove  to  them  that 
"there  is  no  certainty  in  medicine;"  the  quinine  cures  the  ague 


106  DISEASES  OF    CHILDREN. 

to-day,  it  hih  to-morrow ;  it  cures  Smith,  Jones  continues  to 
shake  (?). 

Here  the  diagnosis  has  been  half  made.  In  the  one  case  the 
periodic  cause,  whatever  it  may  be,  was  the  basis  of  the  disease ; 
in  the  other  case  it  was  but  a  part,  and  there  was  something  else 
at  the  bottom.  There  are  many  cases  in  which  the  antiperiodic 
can  not  act,  because  of  some  morbid  conditions  of  the  body; 
correct  these  wrongs,  and  at  once  it  acts  kindly.  Proper  prepara- 
tion for  the  action  of  the  antiperiodic  is  many  times  essential  to 
its  success. 

The  remedies  we  will  study  in  this  connection  are : — 

Quinia  Sulph.  Arsenic,  Alstonia  Constricta, 

Cinchonidia,  Uvedalia,  Nitric  Acid. 

Quinia  Sulphas.  Specific  Indications. — There  is  distinct 
periodicity  in  the  disease,  whatever  else  may  be  its  character,  the 
periodicity  being  marked  by  exacerbations  and  remissions,  or 
intermissions. 

Dose. — In  the  ordinary  use  of  the  remedy  the  antiperiodic 
quantity  will  be  one  grain  for  the  first  year,  two  grains  for  the 
second,  and  so  increase  one  grain  each  year  up  to  the  fifth  or 
sixth,  when  the  dose  will  vary  according  to  the  strength  and 
development  of  the  person.  In  some  cases  very  minute  doses 
prove  antiperiodic ;  in  others  its  limited  absorption  by  the  skin 
when  used  as  an  inunction,  or  applied  to  the  skin  with  alcohol, 
is  sufficient. 

Periodicity  being  the  indication,  we  want  to  know  if  the 
patient  is  in  such  condition  that  the  remedy  will  act,  and  will  act 
kindly.  In  this  case,  as  in  many  others,  a  remedy  must  gain 
entrance  to  the  blood  before  it  can  antagonize  the  disease.  We 
put  it  in  the  stomach  in  an  insoluble  form — the  stomach  must 
first  furnish  an  acid  menstruum  for  its  solution,  and  then  reverse 
the  process  of  osmosis  to  cause  its  absorption.  If  either  of  these 
fail,  the  agent  will  not  prove  curative ;  indeed,  we  might  as  well 
put  it  in  the  patient's  shoes. 

Again,  the  remedy  acts  kindly  in  a  certain  condition  of  body, 
unkindly  in  other  conditions,  and  a  knowledge  of  these  is  essen- 
tial to  its  right  use.  We  say  that  if  the  pulse  is  soft,  the  shin  soft, 
inclined  to  moisture,  the  tongue  moist  and  cleaning,  and  the  nervous 
si/stem  free  from  irritation,  quinine  will  act  kindly,  and  if  there  is 
periodicity,  will  arrest  the  disease.     On  the  contrary,  if  the  pulso 


INFANTILE  THEEAPEUTICS.  107 

is  frequent  and  hard,  the  skin  dry  and  constricted,  the  tongue 
dry,  and  the  nervous  system  excited,  it  will  do  the  patient  harm. 
It  is  true  that  in  some  severe  periodic  disease,  quinine  will  lessen 
the  frequency  of  the  pulse,  bring  down  the  temperature,  control 
irritation  of  the  nervous  system,  and  start  secretion,  but  this  is 
an  exception  to  the  general  rule. 

In  many  cases  of  marked  periodic  disease,  we  first  prepare  the 
patient  for  the  kindly  action  of  the  remedy,,  and  then  administer 
it.  The  child  has  its  Aconite  or  Veratrum  to  control  the  circu- 
lation, baths  to  influence  the  temperature,  Gelseminum,  Rhus, 
Belladonna,  or  whatever  may  be  needed  to  relieve  the  nervous 
system,  and  sometimes  means  to  promote  secretion. 

The  use  of  quinine  by  inunction  is  an  important  means  in  the 
treatment  of  children.  In  many  cases  of  distinct  malarial  dis- 
ease the  remedy  seems  to  be  quite  as  efficient  an  antiperiodic, 
as  if  given  by  mouth.  In  nervous  persons,  and  when  the  remedy 
unpleasantly  influences  the  nervous  system  it  does  much  better. 
In  obscure  periodic  disease,  and  when  the  nervous  systein  requires 
stimulation,  it  will  be  found  an  excellent  method  of  treatment. 

Whilst  I  regard  quinine  as  a  most  valuable  remedy,  in  its 
place,  I  insist  on  the  imViGnt'ion,  periodicity,  fov  its  administration. 
It  will  not  cure  continued  or  typhoid  fever;  it  never  has  arrested 
a  case,  and  never  will,  but  it  has  done  an  immense  amount  of 
harm,  intensifying  the  disease,  increasing  the  suflering,  prolonging 
the  duration,  and  increasing  the  death-rate.  Neither  should  it 
be  used  as  a  stomachic  or  tonic,  for  it  is  neither.  It  is  a  stimu- 
lant to  the  nerve  centers  in  some  cases,  but  the  indications  for 
this  use  are  as  yet  unknown. 

CiNCHOXiDiA.  Cinchonidia  possesses  the  same  properties  as 
quinine,  and  has  the  same  indications.  It  is  claimed  that  it  is 
better  tolerated  by  the  stomach,  and  is  more  easily  taken  by 
children.     The  dose  will  be  the  same. 

Alstonia  Constricta.  Specific  Indications. — The  disease  is 
periodic,  having  exacerbations  and  remissions,  or  intermissions ; 
the  skin  is  dirty  or  tawny,  the  tongue  dirty,  and  the  urine  is 
turbid  and  deposits  a  cloudy  sediment. 

Dose. — The  dose  of  Alstonia  will  be  somewhat  less  than  of 
quinine,  say,  one  grain  the  first  and  second  year,  and  then  an 
increase  of  half  a  grain  a  year. 


108  DISEASES  OF   CHILDEEX. 

Whilst  the  Alstonia  is  not  so  certain  an  antiperiodic  as  quinine 
and  the  other  alkaloids  of  the  Cinchona  barks,  it  stands  next  to 
these,  and  will  meet  cases  where  they  have  failed.  If  the  reader 
will  notice  the  indications — a  dirty,  tawny  skin,  a  dirty  tongue 
and  mouth,  atonic  fullness  of  spleen  and  liver,  he  will  see  that  it 
reaches  very  unpleasant  cases.  When  it  fits  the  case,  it  is  much 
more  likely  to  effect  a  radical  cure,  in  ague,  than  quinine. 

Alstonia  is  also  an  excellent  tonic  and  restorative  in  the  cases 
named,  stimulating  retrograde  metamorphosis  and  excretion,  as 
well  as  nutrition.  It  is  a  new  remedy,  and  needs  further  study 
to  determine  its  full  value. 

Arsenic.  Specific  Indications. — The  pulse  is  soft  and  feeble ; 
skin  inelastic,  pallid  or  dirty ;  tongue  pallid  and  expressionless ; 
eyes  dull ;  tendency  to  hemorrhage  ;  periodicity  in  disease. 

Dose. — We  generally  employ  Fowler's  solution,  adding  from 
one  to  five  drops  to  four  ounces  of  water,  and  giving  a  teaspoon- 
ful  four  times  a  day.  Sometimes  pellets  wetted  with  Fowler's 
solution  answer  a  good  purpose,  and  we  occasionally  use  the 
third  to  the  sixth  decimal  trituration. 

We  have  made  a  study  of  this  remedy  under  the  head  of  reme- 
dies that  influence  the  skin,  and  need  only  notice  it  here  as  it 
is  antiperiodic  and  restorative.  As  a  rule,  we  do  not  employ  it 
in  acute  ague,  or  when  quinine  will  cure ;  it  is  the  old  and  hard 
cases,  and  when  other  remedies  have  failed.  There  is  impairment 
of  the  vital  forces,  and  marked  by  the  indications  given  above, 
we  use  it  as  a  vital  stimulant.  The  reader  will  notice  that 
it  is  the  minute  dose  that  cures,  and  we  do  not  use  it  in  the  old 
doses  for  any  purpose. 

Nitric  Acid.  Specific  Indications. — The  tongue  has  a  violet 
color,  showing  the  ordinary  redness  beneath;  sometimes  the  lips 
and  finger  nails  will  also  show  this  violet  coloration.  ♦ 

Dose. — I^  Nitric  Acid  gtt.  x.,  Water  and  Syrup  aa.  Sj. ;  one- 
half  to  one  teaspoonful  every  three  hours. 

Homoeopathic  Indications  (3d  to  6th  decimal). — Irritable  dispo- 
sition ;  headache,  relieved  on  lying  down  or  riding  in  a  carriage ; 
pain  in  the  bones  of  the  skull,  worse  at  night ;  hardness  of  hear- 
ing, relieved  by  riding  in  a  carriage  or  in  the  cars ;  fetid,  yellow 
discharge  from  the  nose,  bad  odor  from  the  nose,  complete  ob- 
struction of  the  nose;  sore  throat  on  swallowing,  with  sensation 
of  a  sharp  splinter  in  the  throat ;  putrid  smell  from   the  mouth  ; 


INFANTILE  THERAPEUTICS.  109 

the  urine  has  an  oifensive,  strong  odor,  resembling  horses'  urine; 
bad  effects  of  frost-bite  ;  caries. — Ehrmann. 

Nitric  Acid  is  principally  used  in  chronic  ague,  though  we  find 
cases  where  it  will  break  the  paroxysms  and  cure  the  acute.  The 
ordinary  remedies  have  been  used  without  success.  If  now  we 
find  the  violet  coloration  of  tongue,  we  may  be  pretty  sure  of  a 
cure  with  this. 

•  It  is  a  remedy  for  any  form  of  disease  when  this  indication  is 
present.  It  will  influence  the  appetite,  digestion  and  blood- 
making,  give  a  better  circulation  of  blood,  and  improved  waste 
and  excretion.  It  is  one  of  the  remedies  recommended  for 
whooping  cough,  and  if  the  indication  is  present  it  is  very  prompt 
in  its  action.  It  is  also  a  very  good  remedy  in  chronic  bronchitis 
and  some  cases  of  phthisis. 

UvEDALiA.  Specific  Indications. — Enlargement  of  the  spleen 
(ague  cake),  abdomen  full  and  doughy,  fullness  in  hypochondria, 
enlargement  or  hypertrophy  of  any  part,  if  the  tissue  is  atonic, 
doughy  and  inelastic. 

Dose. — For  internal  administration  the  dose  will  vary  from  the 
fraction  of  a  drop  to  five  drops.  The  common  use  is  as  a  local 
application,  an  ointment  of  Uvedalia  being  employed.  In 
ague  cake,  and  asthenic  inflammations,  this  ointment  is  rubbed 
on  and  toasted  in  with  a  hot  iron. 

This  remedy  is  not  properly  an  antiperiodic  except  as  it  influ- 
ences the  spleen,  and  by  restoring  it  to  a  normal  condition, 
removes  the  cause  of  the  continuance  of  the  ague.  For  this  pur- 
pose it  has  no  equal.  In  hypertrophy  and  inflammatory  engorge- 
ments of  parts,  when  there  is  marked  atony,  it  has  proven  a 
useful  remedy. 

ANTI- ERYSIPELATOUS. 

This  may  seem  like  a  singular  classification,  and  the  reader 
may  think  that  this  group  should  have  been  included  with  the 
anti-zymotics.  But  the  disease  is  not  always  zymotic,  and  nei- 
ther can  it  be  classed  with  diseases  of  the  skin,  in  so  far  as  its 
therapeutics  are  concerned.  The  erysipelatous  poison  is  destruc- 
tive, involves  the  blood, 'mucous  membranes,  and  secreting  or- 
gans, and  deep-seated  structures,  as  well  as  on  the  skin. 

If  it  were  one  poison,  and  the  body  were  one,  then  Ave  would 
need  but  one  remedy.     The  fact  is,  however,  that  there  are  a 


110  DISEASES  OF  CHILDREN. 

number  of  remedies,  and  one  cannot  take  the  place  of  the  other. 
We  use  them  by  special  indications ;  if  indicated  they  are  anti- 
erysipelatous,  if  not  indicated  they  are  of  no  advantage  and  may 
do  harm. 

One  will  need  no  better  illustration  of  the  truth  of  specific 
medication  than  is  shown  in  the  study  of  this  group.  If  a  rem- 
edy is  indicated,  and  this  erysipelatous  poison  is  the  basis  of  the 
disease,  the  single  remedy  does  all  for  the  patient  that  one  can 
ask.  If  for  no  other  reason  than  to  see  this  clearly,  we  should 
make  this  study. 

The  remedies  we  will  study  under  this  head  are : — 

Tinct.  Muriate  of  Iron,  Rhus,  Veratrum, 

Sulphite  of  Soda,  Apis. 

TiNCT.  Muriate  of  Iron.  Specific  Indications. — The  tongue 
is  deep  red,  mucous  membranes  deep  red,  the  local  disease  of  the 
skin  shows  the  same  deep  or  dusky  redness. 

Dose. — I^  Tinct.  Muriate  of  Iron,  5ij,  syrup  Sij.  I  give  a 
half  teaspoonful  to  one  teaspoonful  every  twQ  or  three  hours. 
As  a  local  application,  "B^  Tinct.  Muriate  of  Iron  Sss,  Glycerine 
and  Water  aa.  Siij-  Mix. 

When  iron  is  indicated,  and  it  is  in  a  large  number  of  cases, 
its  curative  action  is  wonderful.  Here  is  a  patient  with  a  most 
intense  inflammation  of  the  skin,  with  a  frequent,  hard  pulse,  a 
high  temperature,  an  excited  nervous  system,  a  dry,  harsh  skin, 
scanty  urine,  and  constipated  bowels,  and  the  intensity  of  the 
disease  increasing  from  hour  to  hour.  Muriate  of  iron  is  not  re- 
garded as  a  sedative,  yet  it  brings  the  circulation  and  tempera- 
ture down  to  the  normal  standard ;  it  is  not  thought  of  as  a  rem- 
edy to  relieve  irritation  of  the  nervous  system,  and  yet  it  does  it 
promptly ;  it  is  not  classed  with  diaphoretics,  diuretics,  and 
cathartics,  but  yet  it  restores  the§e  excretions.  At  the  same  time 
it  controls  the  local  disease,  relieving  irritation  and  determina- 
tion of  blood,  and  restores  the  circulation  when  it  has  been  im- 
paired. 

It  has  been  remarked  above  that  the  erysipelatous  poison  may 
influence  any  part,  mucous  membranes  as  well  as  skin,  glandular 
structures,  and  even  nerve  substance.  If  we  find  its  evidences, 
say  in  a  sore  throat  or  disease  of  the  stomach  or  intestines,  or 
elsewhere,  with  an  erysipelatous  tongue,  or  erysipelatous  spots  on 
the  surface,  we  will  think  of  tinct.  muriate  of  iron  as  a  remedy. 


INFANTILE  THERAPEUTICS.  Ill 

Sulphite  of  Soda.  This  remedy  has  been  thoroughly  stud- 
ied, and  we  notice  it  here  to  show  the  difference  in  disease  and  in 
remedies,  even  when  cured  by  one  name.  Here  is  a  case  of  ery- 
sipelas, frequently  deep  seated,  with  a  broad,  pallid  tongue,  dirty, 
and  we  give  sulphite  of  soda  with  as  prompt  relief  as  we  had 
from  the  muriate  of  iron  in  the  preceding  case. 

Ehus.  If  the  local  disease  shows  a  vivid  redness,  with  burn- 
ing pain,  the  pulse  having  a  sharp  stroke,  the  tongue  showing 
bright  red  papillae  at  tip,with  frontal  headache,  rhus  will  be  the 
remedy.  In  this  case  it  controls  the  frequent  pulse,  gives  free- 
dom to  the  circulation,  relieves  irritation  of  the  nervous  system, 
and  cures  the  local  inflammatory  disease  of  the  skin. 

Apis.  The  indications  for  Apis  are,  itching  and  burning  of  the 
skin,  itching  and  burning  of  the  urinary  passages,  and  pinkish 
coloration  of  the  part  involved.  If  these  indications  are  found, 
this  remedy  gives  prompt  relief. 

Veratrum.  If  the  pulse  is  full  and  strong,  and  the  part 
shows  the  redness  of  a  common  acute  inflammation,  no  remedy 
will  prove  more  promptly  curative  than  this.  It  is  given  inter- 
nally in  the  usual  doses,  and  the  part  is  wetted  with  it,  of  full 
strength,  or  down  to  one  part  to  seven  of  water. 

RESTORATIVES. 

Under  this  heading  might  be  included  all  those  agencies  that 
improve  the  life,  the  power  to  make  a  body,  and  that  increase  its 
functional  activity.  Good  functional  activity  comes  from  good 
nutrition,  and  right  conditions  for  the  performance  of  function. 
We  have  already  seen  that  a  right  temperature,  a  right  circula- 
tion, right  innervation,  and  right  excretion,  are  necessary  to 
healtliy  life,  as  is  the  right  quantity  and  quality  of  the  food, 
good  digestion  and  blood-making,  and  right  appropriation  of 
the  material  in  the  building  of  tissue.  The  last  of  these  may  be 
profitably  studied  under  this  head. 

Some  of  these  have  been  already  studied,  as  food,  air  and  exer- 
cise, and  some  of  the  remedies  that  aid  digestion  by  mouth, 
stomach  and  intestine,  and  the  reader  is  referred  to  the  chapter 
on  remedies  that  influence  the  digestive  apparatus,  and  those 
which  influence  the  temperature. 

The  agencies  that  we  will  study  here  are: — 


112  DISEASES   OF    CHILDREN. 


Air, 

Iron, 

Cuprum, 

Light, 

Phosphorus, 

Silica, 

Exercise, 

Sulphur, 

Soda, 

Food, 

Cod  Liver  Oil, 

Lime. 

Tonics, 

Air.  As  a  restorative,  air  is  of  prime  importance,  as  well  as 
a  vehicle  for  the  supply  of  oxygen  to  the  body.  Not  that  the 
body  is  able  to  appropriate  its  nitrogen,  or  withdraw  from  it 
carbon,  as  do  the  plants,  but  it  is  a  stimulant  to  normal  functional 
activity. 

We  find  persons  suffering  from  impaired  nutrition  when  the 
air  is  dead,  i.  e.,  where  its  motion  is  impeded,  and  when  it  fails 
to  receive  its  supply  of  sunshine.  These  are  relieved  by  a  storm, 
accompanied  by  lightning,  which  revivifies  the  air.  They  are 
also  relieved  by  mountain  air,  or  sea-air,  for  similar  reasons. 

The  air  of  a  house,  if  it  is  continuously  closed,  becomes  dead 
air,  even  though  it  is  not  defiled  by  human  excretion,  or  other 
forms  of  dirt.  The  air  is  rejuvenated  by  being  set  in  active 
motion,  and  becomes  a  prominent  restorative.  Dead  air  looks 
towards  impaired  functional  activity  and  death,  air  in  motion 
towards  life. 

Light.  All  life  is  from  the  sun,  and  it  comes  to  this  world 
in  the  form  of  light.  Light,  therefore,  is  an  essential  of  life, 
and  all  that  pertains  to  it,  to  the  making  of  a  human  body,  and  to 
human  functional  activities,  as  well  as  to  the  growth  of  vegetable 
organisms. 

If  a  child  or  an  adult  is  deprived  of  light,  he  suffers  as  do 
plants  when  thus  deprived.  If  one  will  recall  the  growth  of  a 
potato  in  a  cellar,  its  blanched  and  feeble  appearance,  its  struggles 
towards  the  few  rays  of  light  that  gain  entrance,  he  can  see  how  a 
human  being  will  suffer  when  deprived  of  this  life-giving  agent. 

The  human  body,  like  plant  life,  requires  the  full  ray — white 
light — for  health,  though  some  diseases  of  the  one  as  of  the  other 
are  relieved  by  parts  of  this  ray,  as  the  blue,  yellow,  red,  etc. 
The  human  body  also  requires  the  direct  ray,  and  can  not  main- 
tain a  good  condition  of  health  if  obliged  to  depend  upon  re- 
flected light. 

It  has  already  been  remarked  that  air  deprived  of  sunlight  be- 
comes dead,  the  plant  deprived  of  sunlight  becomes  sickly  and 
eventually  dies,  and  the  child  deprived  of  sunlight  sickens,  and 
may  die  from   the    deprivation.     Light  is  a  stimulant,  and  we 


INFANTILE   THERAPEUTICS.  113 

employ  it  in  diseases  of  debility.  If  a  child  is  suffering  from 
asthenic  disease,  and  is  confined  to  a  room  on  the  north  side  of 
the  house,  or  the  light  is  cut  off  by  houses  or  trees,  we  at  once 
suggest  the  propriety  of  such  change  as  will  bring  sunshine  into 
the  room  a  considerable  part  of  the  day.  Bitter  tonics  and  re- 
storatives have  failed,  sunshine  is  the  restorative  indicated. 

We  have  cases  in  which  the  cure  comes  from  the  free  light  out 
of  doors,  and  we  insist  that  the  little  sufferer  shall  have  it  every 
day.  In  some  cases  v/e  use  the  sun-bath  with  good  effect ;  the 
entire  body,  except  the  head,  may  be  exposed  to  the  direct  rays 
of  the  sun  before  a  window,  or  if  a  part  is  feeble  this  only  may 
be  exposed  to  the  sun. 

In  some  cases  the  white  ray  is  broken  up,  and  we  use  but  a 
part  of  it — this  part  now  has  color.  If  we  want  sedatives,  the 
color  is  yellow  or  green  ;  if  stimulation,  red  or  blue.  An  alter- 
nate blue  and  white  light  exerts  a  peculiar  influence  upon  the 
body,  that  can  hardly  be  classed  as  stimulant  or  sedative.  It  is 
stimulant  to  a  plant  and  improves  its  nutrition,  but  upon  the 
human  body  it  seems  rather  to  increase  waste. 

If  a  patient  is  suffering  from  nervous  irritation,  or  acute  local 
disease,  we  find  that  yellow,  green  or  leaden  colored  window 
shades,  and  wall  papers  exert  a  markedly  soothing  influence.  If 
on  the  contrary  there  is  a  feeble  circulation  and  innervation, 
poor  nutrition,  and  general  asthenia,  we  find  benefit  from  pink 
or  red  shades  and  papers,  and  sometimes  from  blue.  It  is  the 
same  with  clothing.  If  an  anemic  patient  is  clothed  in  yellow,  I 
suggest  the  change  to  pink  or  red-. 

Exercise.  The  necessity  of  right  exercise  to  health  of  body 
has  already  been  referred  to,  as  well  as  the  necessity  of  rest,  in 
conditions  of  irritation.  Every  part  is  made  for  use,  and  main- 
tains its  structure  because  it  is  rightly  used.  If  it  is  disused,  it 
is  eventually  lost. 

Right  exercise  is  as  essential  to  the  life  of  the  child  as  the 
adult.  Nutrition  of  the  body  depends  upon  it,  and  a  good  body 
cannot  be  grown  without  it.  It  is  the  same  of  a  part,  if  not  used 
it  is  atrophied  ;  and  in  such  cases  right  exercise  becomes  a  promi- 
nent restorative.  If  the  exercise  can  not  be  taken  in  the  natural 
way,  we  have  the  parts  rubbed  and  kneaded,  and  use  passive  move- 
ment. Many  deformities  in  childhood  grow  from  disease  of  parts; 
they  are  corrected  by  exercise,  either  passive  movement  or 
movement  under  the  influence  of  the  will. 


114  DISEASES   OF  CHILDREN. 

Food.  One  of  the  most  important  objects  in  the  treatment  of 
disease  is  to  place  and  keep  the  stomach  in  such  condition  that  a 
portion  of  food  may  be  taken  and  digested  every  day.  Foods 
are  of  two  kinds — calorifacient  and  histogenetic — heat-producing 
and  tissue-making.  The  first  of  these  is  of  the  most  importance 
is  some  forms  of  disease,  the  last  in  others.  We  can  not  attempt 
to  define  the  indications  for  one  or  the  other  here,  but  will  give 
some  simple  rules  which  may  guide  us  in  selecting  and  giving 
food : 

"  1.  Solid  food  should  rarely  be  given  during  the  progress  of 
an  acute  diseas^e,  as  the  stomach  and  digestive  organs  are  not  in 
a  condition  to  furnish  the  fluids  necessary  for  its  proper  commi- 
nution, and  hence  it  does  not  digest,  but  decomposes,  giving  rise 
to  irritation  and  other  annoying  results, 

"  2.  As  a  general  rule,  the  severer  the  disease,  and  the  fur- 
ther the  system  is  from  a  condition  of  health,  the  lighter  and 
more  diluted  should  be  the  food.  Thus,  in  a  high  grade  of  fever 
or  inflammation,  we  would  give  whey,  toast-water,  thin  farina, 
or  tapioca,  weak  chicken  or  mutton  broth,  etc. 

"  3.  In  states  of  great  exhaustion  the  food  should  be  concen- 
trated, very  nutritious,  and  yet  deprived,  as  far  as  possible,  of  all 
material  that  can  not  be  appropriated  by  the  stomach.  Thus  we 
would  give  beef  essence,  concentrated  chicken,  or  mutton  tea, 
farina  with  milk,  etc. 

"  4.  In  all  febrile  and  inflammatory  diseases  the  food  should 
be  given  at  that  period  of  the  day  in  which  there  is  least  vascu- 
lar and  nervous  excitement,  and  it  should  never  be  forced  on 
the  patient  when  suffering  from  high  fever. 

"  5.  Never  give  food  when  the  patient  is  suffering  from  severe 
pain,  as  at  such  times  it  is  impossible  for  the  digestive  organs  to 
appropriate  it. 

"  6.  If  the  tongue  is  heavily  coated  with  a  yellowish  coat,  a  bad 
taste  in  the  mouth,  and  a  feeling  of  weight  and  oppression  at  the 
stomach,  it  is  better  not  to  give  food,  or  at  least  give  it  in  a  fluid 
form  and  in  small  quantity. 

"  7.  Never  force  food  on  a  patient  when  his  stomach  revolts 
at  it,  or  if  it  produces  nausea,  oppression,  or  pain.  It  is  much 
better  to  wait  until  medicine  or  time  has  placed  the  stomach  in 
a  condition  to  digest  it. 

"  8.  When  the  digestive  powers  are  much  impaired,  and  it  is 


INFANTILE  THERAPEUTICS.  115 

important  to  give  food  to  sustain  the  strength,  it  should  be  given 
in  small  quantities,  and  at  regular  intervals,  like  medicines. 

"  9.  If  there  is  an  absolute  demand  for  nourishment  to  sustain 
the  strength  of  the  patient,  and  it  can  not  be  given  by  mouth,  it 
is  sometimes  an  excellent  plan  to  administer  it  as  an  injection. 

"  10.  Much  care  is  necessary  during  convalescence  from  dis- 
ease that  the  patient  does  not  eat  too  much,  or  that  -which  is 
indigestible.  The  digestive  organs  are  now  enfeebled,  and,  if 
overworked,  there  is  not  only  an  excess  of  imperfectly  elaborated 
material  taken  into  the  system,  but  the  exhaustion  is  extended 
to  the  entire  body,  and  impairs  the  functions  of  other  organs 
and  parts." 

Tonics.  Tonics  may  well  be  classed  with  restoratives,  as  the 
end  of  both  is  to  improve  nutrition.  The  difficulty  in  the  way 
of  the  administration  of  tonics  with  children,  is  their  bitter,  un- 
pleasant taste.  Many  remedies,  therefore,  that  we  should  like  to 
use  have  to  be  excluded  on  this  account. 

QuiNiA.  I  employ  quinia  internally  in  the  diseases  of  children, 
only  for  its  specific  influence  in  antagonizing  the  malarial  poison. 
Though  it  is  one  of  our  most  powerful  nerve  stimulants,  and  in 
some  cases,  aids  digestion  and  nutrition  in  a  marked  manner,  its 
taste  is  so  unpleasant  as  to  prevent  its  ordinary  use. 

In  some  cases  where  this  stimulant  influence  upon  the  nervous 
system  is  required,  we  may  use  the  Triple  Phosphate  of  Quinia, 
Strychnia  and  Iron,  (Aitkin's  Tonic  Mixture).  It  is  a  powerful 
remedy,  and  in  many  cases  it  will  restore  the  appetite,  improve 
digestion  and  blood-making,  and  aid  nutrition  in  a  mars'elous 
manner.  As  the  dose  for  a  child  need  not  be  more  than  five  or 
ten  drops  three  times  a  day,  the  child  will  sometimes  take  it 
without  objection.  It  may  be  prescribed  as  follows  :  I^  Corap. 
Tonic  Mixt.  5ss.,  Simple  Syrup  5iss. ;  half  a  teaspoonful  three 
times  a  day.  , 

CoLLiNSONiA.  The  Collinsonia  Canadensis  is  a  very  valuable 
remedy,  possessing  as  it  does  an  influence  upon  several  parts  of 
the  body.  The  proportion  for  a  child  two  years  old  will  be  : 
^  Tincture  Collinsonia  5ss.,  Simple  Syrup  Si'jss.,  Mix. ;  dose 
from  one-half  to  one  teaspoonful. 

To  improve  the  appetite  and  aid  digestion  it  may  be  adminis- 
tered in  connection  with  iron,  cod-liver  oil,  etc.     It  is  not  bitter. 


.116  DISEASES  OF  CHILDREN. 

but  quite  pleasant  to  the  taste,  and  sits  very  kindly  upon  the 
stomach. 

In  chronic  diseases  of  the  respiratory  apparatus  it  is  a  favorite 
remedy,  having  a  specific  influence  in  removing  irritation  and 
improving  functional  activity  of  all  parts  supplied  by  the  sympa- 
thetic system  of  nerves. 

Iron.  Iron  is  a  most  efficient  tonic  and  restorative  in  child- 
hood. It  can  be  so  prepared  as  to  be  readily  taken  and  well 
appropriated  by  the  stomach.  As  a  general  rule,  it  should  not 
be  administered  while  there  are  evidences  of  fever,  or  during  the 
progress  of  inflammation.  And  in  the  treatment  of  chronic 
disease  it  will  rarely  be  of  benefit  so  long  as  the  secretions  are 
locked  up. 

I  prefer  the  following  preparations :  I^  Tincture  of  Muriate 
of  Iron  5ij',  Glycerine  or  Syrup  .^iv. ;  dose  a  teaspoonful  three 
or  four  times  a  day.  I^  Citrate  of  Iron  3ss.,  Water  Sj- ;  dissolve 
and  add  Glycerine  or  Syrup  Sijj-j  niix ;  dose,  a  teaspoonful  three 
or  four  times  a  day. 

Phosphorus.  Phosphorus  may  sometimes  be  employed  with 
advantage  as  a  restorative.  Different  preparations  are  in  use, 
but  I  think  the  best  are  the  Hypophosphite  of  Lime,  Hypophos- 
phite  of  Soda,  and  Compound  Syrup  of  the  Hypophosphites.  Of 
the  first,  the  dose  will  be  one  grain ;  of  the  second  one  or  two 
grains;  and  of  the  syrup,  one-third  of  a  teaspoonful  three  or 
four  times  a  day. 

The  indications  for  the  use  of  phosphorus  are,  a  pale,  doughy 
condition  of  the  skin,  cold  extremities,  abundant  pale  urine  of 
low  specific  gravity,  and  deficient  innervation. 

Sulphur.  Though  not  regarded  as  a  tonic,  or  even  as  a 
restorative,  I  regard  sulphur  as  a  very  important  restorative  in 
some  exceptional  cases.  It  is  not  very  easy  to  indicate  the  cases 
in  which  it  is  most  useful,  but  they  are  those  in  which  there  is  a 
deficiency  of  heat  and  impairment  of  muscular  power.  I  use  it 
in  doses  of  three  to  five  grains,  associated  with  cod-liver  oil,  or 
other  fatty  material. 

CoD-LiVER  Oil.  This  is  a  very  important  restorative  in  many 
cases  where  the  nutritive  powers  are  impaired.  It  furnishes 
material  for  combustion,  and  thus  saves  the  nitrogenized  food 


INFANTILE  THEEAPEUTICS.  117 

and  tissues  from  being  burned.  It  also  furnishes  food  for  the 
nerve  centers  in  a  form  readily  appropriated.  Cod-liver  oil,  when 
the  stomach  will  receive  it  kindly,  is  easily  digested,  and  increas- 
ing the  temperature  and  the  innervation  of  the  body,  all  the 
functions  are  better  performed. 

The  dose  of  cod-liver  oil  for  a  child  two  years  old,  will  be  a 
teaspoonful  three  or  four  times  a  day. 

Cuprum,  Specific  Indications. — The  skin  has  a  tawny  or 
dirty  hue,  sometimes  greenish,  the  tongue  is  pale,  and  the  gums 
blanched,  the  pulse  is  small  and  soft,  and  more  frequent  than 
usual.  Discharges  from  the  bowels  lack  color,  and  if  there  is 
diarrhoea,  they  are  pale  and  like  rice  water. 

Dose. — ^  Tinct.  Acetate  of  copper  (Rademacher's)  gtt,  x,, 
water  Siv. ;  a  teaspoonful  four  times  a  day.  Sometimes  we  get 
the  restorative  action  of  copper  by  having  the  patient  take  it  in 
the  shape  of  a  greened  pickle — a  small  portion  three  times  a  day. 

Homoco'pathic  Indications,  (3d  to  6th  decimal). — Spasmodic  affec- 
tions, whooping  cough  with  spasms,  long  continued  paroxysips 
of  suffocation,  cough,  much  rattling  of  mucus ;  epilepsy  ;  violent 
diarrhoea  with  cramp  in  the  stomach  and  chest,  much  flatus  with 
the  stool,  nausea  and  vomiting  of  frothy  mucus,  sometimes  green, 
metallic  taste ;  pulse  small,  soft,  almost  imperceptible ;  scarlet 
fever  when  the  rash  suddenly  disappears,  followed  by  stupor  and 
delirium  or  convulsions. — Ehrmann. 

Silica.  Specific  Indications. — The  skin  is  rough,  the  epider- 
mis desquamates,  and  the  hair  is  harsh ;  teething  is  slow,  and  the 
tissues  feeble. 

Dose. — I  employ  the  third  decimal  trituration  as  a  remedy ; 
usually  I  order  an  oatmeal  or  cracked  wheat  diet,  or  the  use  of 
bread  from  unbolted  flour. 

Homoeopathic  Indications  (3d  to  6th  decimal). — Headache  with 
great  sensitiveness  to  a  draft  of  air.  Must  have  the  head  covered. 
Great  inclination  to  perspire.  Hardness  of  hearing.  Otalgia 
with  stitching  pains.  Nasal  catarrh  with  offensive  odor  and  loss 
of  smell.  Inflamed  glandular  swellings.  Fistulous  ulcers. 
Ulcers  burning,  putrid,  indolent.  Carbuncles.  The  skin  heals 
badly;  a  slight  injury  inclines  to  suppurate.  Bones  swollen, 
inflamed.  Caries.  Weakness  of  the  joints,  especially  the  ankle. 
Feet  perspire  very  much,  and  smell  very  offensively.     Phthisis 


118  DISEASES  OF    CHILDREN. 

pulmonalis,   with    great    sensitiveness  to   a  draft   of   air,  and 
profuse  night  sweats. 

Soda.  This  remedy  has  been  studied  in  two  or  three  places, 
and  we  only  need  say  here  that  when  the  tongue  is  continuously 
pallid  and  broad,  it  will  be  found  a  good  remedy.  It  improves 
the  appetite,  digestion  and  blood-making,  and  the  nutrition  of 
tissues. 

Lime.  Specific  Indications.— Acid  fermentation  in  the  stomach, 
food  does  not  digest  well,  colic,  green  acrid  discharges  from  the 
bowels,  inflammation  of  cellular  tissues,  boils. 

Dose. — When  we  wish  to  influence  the  digestive  tract  we  use 
lime-water  with  the  milk.  If  it  is  for  inflammation  of  the  cellular 
tissues,  or  boils,  we  may  use  lime-water,  or  minute  doses  of  sul- 
phide of  lime. 


FA.RT    II. 

CARE  AND  MANAGEMENT  OF  INFANTS. 


CHAPTER    III. 


The  young  of  man  is  the  most  helpless  of  all  created  beings, 
requiring  constant  care  from  the  hour  of  birth  until  its  second  or 
third  year.  But  it  is  especially  for  a  short  time  after  birth  that 
it  is  thought  to  need  extra  attention,  and  when  it  very  frequently 
gets  an  officious  interference  that  renders  it  uncomfortable,  and 
frequently  leads  to  disease. 

Many  of  the  prejudices  and  whims  of  the  olden  time  still  re- 
main, and  some  of  them,  indeed,  receive  the  tacit  support  of  the 
physician.  It  is  well  to  educate  the  public  mind  to  the  truth 
in  these  things,  and  though  the  physician  may  find  it  a  thankless 
task  at  first,  it  will  bring  its  return  in  an  increased  confidence 
and  respect. 

Works  on  obstetrics  point  out  the  things  to  be  done,  and  how 
to  do  them.  It  will  be  our  business  here,  at  least  to  some  extent, 
to  point  out  some  things  that  should  not  be  done,  and  other 
things  that  are  not  done  properly. 

Washing  the  Child. — A  physician  should  not  have  the 
least  hesitation  in  telling  a  nurse  how  to  wash  the  child,  if  she 
shows  ignorance  in  regard  to  it.  A  very  common  plan  is,  to  rub 
the  child  with  lard  freely,  and  then  with  an  ordinary  cloth,  and 
poor  soap  and  lukewarm  water,  to  wash  off  the  grease  and  secre- 
tions upon  the  skin.  It  is  a  difficult  job,  and  the  child  is  rubbed 
until  its  skin  is  irritated,  and  still  not  cleansed,  and  it  is  ren- 
dered fretful  and  uneasy  for  days. 

(119) 


120  DISEASES  OF  CHILDREN. 

The  true  way  is,  let  the  person  washing  the  child  rub  it  thor- 
oughly with  the  lard,  and  then  with  a  piece  of  soft  flannel,  or 
even  cotton,  wipe  the  child  clean.  Then  with  soap  and  water, 
and  a  soft  cloth  or  sponge,  it  may  be  gently  yet  thoroughly  washed. 
The  drying  had  better  be  done  by  gently  pressing  the  towel  or 
cloth  upon  the  skin,  rather  than  by  rubbing.  This  makes  all 
the  difference  possible  in  the  feelings  of  the  child  and  its  future 
comfort.  And  as  the  skin  has  a  very  close  sympathy  with  other 
parts,  in  addition  to  being  an  extremely  sensitive  part  itself,  we 
can  readily  see  that,  in  some  cases  at  least,  it  will  be  a  means  of 
avoiding  serious  disease. 

Clothing  of  the  Child. — I  object  most  decidedly  to  many 
parts  of  the  infant's  dress,  as  usually  made ;  and  I  have  no  hesi- 
tation in  giving  my  objections  words,  whenever  and  wherever  I 
am  brought  into  contact  with  these  errors. 

The  bandage  of  the  child  is  always  pinned  too  tightly.  The 
child  no  more  needs  this  swathing  than  the  adult ;  its  abdominal 
muscles  are  just  as  strong,  and  just  as  capable  of  performing  their 
functions.  But  there  is  something  worse  than  the  mere  suffering 
which  follows  such  confinement.  The  bandage  extends  upward 
so  as  at  least  to  embrace  the  floating  ribs,  hence  the  insertion  of 
the  diaphragm,  and  often  much  higher.  Here  there  is  a  more  or 
less  serious  impairment  of  the  respiratory  function,  as  the  band 
is  more  or  less  tightly  applied.  We  not  only  have  suffering  and 
restlessness  upon  the  part  of  the  child  from  this,  but  occasionally 
such  impairment  of  the  lungs  as  will  lead  to  a  fatal  result. 

There  is  another  lesion  that  may  be  directly  attributed  to  this. 
I  allude  to  infantile  constipation.  It  comes  on  gradually ;  it  is 
attended  with  colic,  and  sometimes  with  infantile  dyspepsia. 
True,  in  many  eases  it  does  not  produce  any  present  marked 
inconveniences,  but  it  lays  the  foundation  for  future  constipation, 
hemorrhoids,  prolapsus  ani,  and,  as  I  believe,  for  hernia. 

The  child  needs  such  band  only  for  the  purpose  of  retaining 
the  dressings  of  the  cord,  and  to  give  warmth.  One  thickness 
of  soft  and  elastic  flannel,  not  so  wide  as  to  extend  upward  on 
the  thorax,  or  down  to  be  wet  with  the  excretions,  will  answer 
this  purpose.  Being  elastic,  it  maintains  its  place  without  being 
applied  so  tightly. 

Its  skirts  are  usually  as  badly  made.  The  waist  is  made  of 
cotton  stuff,  usually  stiff  and  harsh,  and  so  wide  as  to  prevent 


CARE  OF  INFANTS.  121 

any  warmth  from  the  flannel  attachment.  As  frequently  put  on 
it  chafes  the  child  under  the  arms,  and  is  unpleasantly  bulky  and 
cumbersome  about  the  body. 

The  diaper  is  as  bad  or  worse  than  the  remainder.  If  the 
parents  are  in  good  circumstances,  and  it  is  a  first  child,  it  will  be 
of  linen  diaper ;  at  any  rate  it  will  be  harsher  than  there  is  any 
need  for.  Let  this  be  wetted  and  dried  several  times  without 
washing,  and  we  have  a  cause  of  irritation  that  would  make  the 
adult  wince  if  obliged  to  wear  it.  I  have  seen  scores  of  cases  in 
which  irritation  and  chafing  about  the  genitals,  the  perineum, 
nates,  and  thighs,  was  the  result  of  such  treatment.  Yet  the 
mother  could  not  imagine  why  her  child  should  be  so  affected. 

While  I  do  not  insist  that  they  should  be  washed  after  each 
discharge  of  urine,  though  it  would  be  better  and  pleasanter  for 
the  child  if  they  were,  I  object  to  their  being  used  until  they 
smell  and  are  as  foul  as  it  is  possible  for  so  much  linen  or  cotton 
to  get.  If  children  are  delicate,  the  absorption  of  these  excre- 
tions must  prove  very  detrimental. 

When  a  child  shows  such  irritation  as  I  have  named,  recom- 
mend that  the  diapers  be  made  of  canton  flannel,  which  is  soft, 
unirritating  and  pleasant,  and  that  they  be  rinsed  in  clean  water 
every  time  they  are  soiled,  before  drying  and  using. 

How  OFTEN  SHOULD  THE  ChILD  BE  WASHED  ? — The  questioD 

might  be  put  in  a  different  way — not  so  much  how  often,  but 
how  much  should  the  child  be  washed  ?  Some  are  washed  a  very 
great  deal ;  indeed,  some  poor  innocents  have  their  lives  soaked 
out  of  them. 

It  would  be  a  mercy  to  the  children  to  put  a  few  monthly 
nurses,  and  not  a  few  mothers,  through  a  similar  course  of  soap 
and  water,  as  afterward  they  would  hardly  be  so  free  with  it. 

I  have  seen  children  washed  out  of  the  world  in  a  few  months, 
and  sometimes  in  a  few  weeks,  and  have  had  to  put  a  stop  to  it  a 
number  of  times.  The  child  is  very  sensitive  to  cold,  and  being 
entirely  divested  of  clothing,  and  having  the  evaporation  of 
water  from  the  surface  for  some  minutes,  is  too  much  for  many. 

To  wash  a  child  properly,  the  nurse  should  have  a  blanket  or 
other  woolen  material  of  sufficient  size  to  wrap  the  child  entirely 
up.  Then  a  portion  of  the  body  should  be  washed  at  a  time,  the 
child  being  kept  well  covered  in  the  meanwhile.  Even  with 
this  care  it  is  not  necessary  that  the  child  be  washed  every  day. 


122  DISEASES   OF  CHILDREN. 

Washing  is  done  for  cleanliness,  and  need  not  go  further  than 
that ;  and  when  children  are  feeble  it  had  better  fall  short  of  it 
than  exceed  it. 

Attention  to  the  Cord. — The  question  is  usually  asked, 
how  long  will  it  be  before  the  cord  falls  off?  and  what  shall  we 
do  with  it  in  the  meantime  ?  It  usually  requires  from  five  to 
nine  days  for  the  separation  of  the  cord,  and  cicatrization  of  the 
umbilicus,  and  occasionally  it  is  prolonged  beyond  this. 

It  is  important  that  the  cord  be  tied  sufficiently  tight  to  pre- 
vent any  hemorrhage.  True,  it  is  but  rare  that  there  is  any 
severe  hemorrhage,  yet  I  have  had  such  in  my  practice.  But  a 
small  amount  of  blood  discharged  causes  the  cord  to  adhere  to 
the  cloth,  and  the  mass  becomes  hard  and  unpleasant,  if  not 
irritant  to  the  child.  I  always  recommend  the  young  physician 
to  examine  the  cord  before  it  is  dressed,  and  if  not  certain  in 
regard  to  this  point,  to  apply  a  second  ligature. 

The  cloth  with  which  the  cord  is  dressed  should  have  its  upper 
surface  oiled  (in  obstetrics  we  say  oil  when  we  mean  lard),  so  that 
it  may  not  adhere  if  it  should  become  necessary  to  remove  it. 
Every  day  when  the  child  is  dressed,  it  should  be  placed  in  such 
a  position  that  there  will  be  no  strain  upon  it.  And  in  washing 
the  child,  the  cord  and  cloth  should  be  removed,  so  as  to  wash 
beneath  it. 

In  the  majority  of  cases,  irritation  and  inflammation  about  the 
umbilicus  is  the  result  of  tension  upon  the  cord,  upon  the  dress- 
ing becoming  hard  and  irritant  from  bleeding,  or  other  cause, 
from  a  too  tight  band,  or  from  the  excretions  passing  up  so  as  to 
soil  the  dressings  of  the  cord,  and  subsequent  want  of  cleanliness. 

No  traction  or  other  means  should  be  used  to  remove  the 
cord,  as  it  will  be  separated  in  due  time  by  the  natural  process  of 
absorption. 

When  separated  it  is  well  to  apply  a  soft  cotton  cloth,  folded, 
that  the  recent  cicatrix  may  not  be  disturbed  by  the  rubbing  of 
the  child's  clothes.  If  the  part  seems  somewhat  tender,  a  cloth 
spread  with  mutton  suet  or  simple  cerate  may  be  applied. 

Ulceration  of  the  Umbilicus. — Occasionally  we  are  called 
to  prescribe  for  ulceration,  or  rather  a  want  of  cicatrization  of  the 
umbilicus.  Sometimes  there  is  considerable  redness  and  evidences 
of  inflammatory  action,  and  the  child  is  feverish  and  fretful. 

I  generally  prescribe  one  of  three  things.     In  the  majority  of 


CARE   OP   INFANTS.  123 

cases,  that  the  part  be  powdered  with  subnitrate  of  bismuth  twice 
daily.  It'  there  is  much  inflammation,  that  it  be  dressed  with 
stramonium  ointment.  Or,  if  there  is  an  erysipelatous  redness, 
order  a  solution  of  permanganate  of  potash,  one  grain  to  the 
ounce  of  water. 

If  the  child  is  feverish  and  restless,  we  would  give  Aconite, 
one  drop  to  the  ounce  of  water,  one-half  of  a  teaspoouful  every 
hour. 

Excoriation  and  Chafing. — Various  parts  of  the  infant's 
body  may  be  chafed,  and  become  excoriated,  and  painful.  I 
have  already  mentioned  the  chafing  that  comes  from  want  of 
attention  to  the  diapers  of  the  child,  and  want  of  cleanliness.  It 
is  quite  easy,  by  inspection,  to  determine  the  nature  of  the 
difficulty,  but  it  is  not  always  so  easy  to  give  immediate  relief. 

The  use  of  Colgate's  Glycerine  Soap  to  wash  the  child,  and 
strict  attention  to  cleanliness,  will  sometimes  be  all  that  is  neces- 
sary. Occasionally  dusting  the  inflamed  parts  with  scorched 
flour  will  answer  the  purpose.  The  common  idea  is  that  some- 
thing "  greasy  "  is  necessary,  and  frequently  ointments  will  have 
been  used  before  the  physician  is  spoken  to.  Mutton  suet,  if 
well  prepared,  answers  as  well  as  any  ointment,  if  we  except  the 
glycerole  of  starch,  which  is  an  excellent  application  in  such 
cases.  The  most  certain,  as  well  as  the  speediest  cure,  has  fol- 
lowed the  use  of  subnitrate  of  bismuth  in  fine  powder,  dusted 
over  the  parts,  two  or  three  times  a  day. 

Does  the  Child  need  Medicines  immediately  after 
Birth? — Many  persons  believe  that  the  young  child  needs  some- 
thing to  act  upon  its  bowels.  And  for  this  purpose  they  propose 
to  give  it  urine  and  molasses,  lard  and  molasses,  or  sometimes 
castor  oil.  Others  think  it  should  have  a  whisky  or  rum  mix- 
ture, to  work  the  mucus  out  of  its  throat. 

The  truth  is,  the  less  the  child  is  interfered  with  the  better  it 
will  get  along.  Nature  makes  provision  for  all  of  its  wants,  and 
an  action  of  the  bowels  is  provided  for  in  the  first  milk  of  the 
mother.  The  child  will  have  a  sufficient  opportunity  to  take 
medicine,  without  commencing  thus  early,  and  it  will  be  good 
policy  to  impress  this  upon  the  mother  and  nurse. 

There  is  no  need  of  saffron  tea  to  keep  off  the  jaundice,  or 
make  the  child  a  better  color.     No    need  of  German  chamomile 


124  DISEASES  OF  CHILDEEN. 

to  strengthen  its  stomach,  or  of  pap  or  panada,  or  of  any  of  the 
hundred  and  one  things  that  people  like  to  force  upon  the  child. 
What  it  wants  is  warmth  and  quiet,  and  not  food  or  medicine. 
Nature  furnishes  food  at  the  proper  time,  and  furnishes  it  exactly 
adapted  to  its  wants. 

Difficulties  in  Nursing  the  Child. — Occasionally  we  find 
a  child  that  will  not  nurse,  at  least  it  persistently  refuses,  and 
accompanies  its  refusal  by  energetic  remonstrances.  This  seems, 
in  some  cases,  an  excellent  illustration  of  original  sin,  though, 
doubtless,  there  is  some  good  cause,  other  than  this,  if  we  but 
knew  it. 

If  the  child  is  fed  the  difficulty  increases  as  time  progresses ; 
for,  becoming  accustomed  to  the  spoon  or  bottle,  he  is  less  in- 
clined to  take  the  breast.  The  proper  way  is,  not  to  feed  the 
child,  but,  by  kindness  and  perseverance,  get  it  to  nurse.  The 
child  should  be  applied  to  the  breast  when  in  a  good  humor,  and 
not  when  crying ;  sometimes  it  will  be  an  advantage  to  wet  the 
nipple  with  the  milk,  as  an  extra  inducement. 

In  some  cases  the  difficulty  is  with  the  mother,  not  with  the 
child.  The  nipples  are  retracted,  or  not  properly  formed,  and 
the  child  is  unable  to  obtain  a  sufficient  hold  to  draw  the  milk. 
In  this  case  a  breast-pump,  applied  for  a  moment,  will  draw  the 
nipple  out  so  that  the  child  can  nurse.  If  a  breast-pump  is  not 
at  hand,  it  may  be  accomplished  with  an  ordinary  pint  bottle;  fill 
it  with  hot  water,  and  pouring  it  out  quickly,  apply  to  the  breast. 

The  sore  nipple  that  is  so  frequently  met  with,  and  that  proves 
such  an  annoyance  and  source  of  difficulty  in  nursing,  is  best 
cured  by  wearing  a  leaden  nipple  shield,  and  small  doses  of  Phy- 
tolacca with  or  without  Aconite.  If  sheet-lead  can  be  readily 
obtained,  this  may  be  easily  fashioned  into  a  cup  that  will  accu- 
rately fit  the  nipple.  If  not,  a  piece  may  be  hammered  from 
ordinary  bar  or  other  lead.  We  want  it  to  fit  accurately  and 
pleasantly,  so  as  to  bring  it  in  contact  with  every  part  of  the 
nipple.  It  should  not  be  too  heavy,  as  it  is  to  be  constantly  worn, 
except  when  the  child  is  nursing.  It  has  often  seemed  strange  to 
me  that  with  so  simple  and  certain  a  means  of  cure,  such  suffisr- 
ing  should  be  permitted. 

Food  of  the  Child. — The  natural  food  of  the  child  for  the 
first  eight  months,  is  the  mother's  milk,  and  it  is  rarely  the  case, 
when  the  mother  is  healthy,  that  any  other  food  will  be  required. 


CARE  OF  INFANTS.  125 

If  the  mother  is  healthy,  and  still  fails  to  supply  the  amount 
necessary,  the  probabilities  are  that  there  is  a  deficiency  of  some 
kinds  of  food.  Frequently  it  will  be  of  farinaceous  foods,  which, 
if  prepared  in  palatable  form,  give  an  increase  of  good  milk. 
Occasionally  the  fault  will  be  found  in  a  lesion  of  digestion,  and 
the  employment  of  the  bitter  tonics  and  restoratives  will  answer 
the  purpose. 

When  the  child  can  not  have  its  natural  food  we  have  to  advise 
a  substitute.  That  most  readily  obtained  and  easily  prepared  is 
the  milk  of  the  cow.  In  its  natural  condition  it  is  too  rich  in 
some  of  the  elements  of  food,  too  poor  in  others.  The  constitu- 
ents of  human,  cow's  and  goat's  milk  are  as  follows: 

HUMAN.  cow.  GOAT. 

Water 883.6 861.0 868.0 

Butter 25.3 38.0 33.2 

Casein 34.3 68.0 40.2 

Sugar  of  Milk  and  Extractive  Matters 48.2 29.0 52.8 

Fixed  Salts 2.3 6.1 5.8 

To  prepare  the  milk  of  the  cow  for  food  for  the  child  during 
the  first  weeks  of  life,  one-third  the  quantity  of  water  should  be 
added,  and  one  drachm  of  sugar  to  the  pint  of  milk,  and  the 
whole  boiled.  After  the  first  month,  the  proportion  of  water 
may  be  lessened  to  one-fourth,  and  after  the  child  has  passed  its 
sixth  month  it  may  be  given  pure. 

Those  who  have  had  occasion  to  use  artificial  food  in  raising 
children,  prefer  the  milk  of  the  goat  to  the  cow,  and  there  is  no 
doubt  but  that  it  is  more  easily  appropriated  by  the  child.  In 
France,  goats  are  frequently  trained  so  that  they  will  lie  down 
and  permit  the  child  to  nurse  directly  from  the  udder. 

Liebig's  food  is  a  most  excellent  substitute  for  the  mother's 
milk,  being  much  better  than  the  milk  of  the  cow.  It  contains 
the  elements  of  human  milk  in  a  form  easily  digested  by  the 
child.  It  is  composed  of  Wheaten  Flour,  two  ounces;  Barley- 
malt  Flour,  two  ounces ;  and  Bicarbonate  of  Soda,  thirty-one 
grains.  In  preparing  it  for  use,  the  following  directions  are 
observed : 

Take  a  heaping  tablespoonful  of  the  powder  and  mix  it  with 
two  tablespoonfuls  of  water ;  then  add  to  it  ten  tablespoonfuls 
of  milk,  and  heat  the  whole  over  a  gentle  fire  (do  not  boil). 
When  the  mass  begins  to  thicken,  remove  it  from  the  fire,  and 
stir  for  five  minutes.     Then  place  it  over  the  fire,  and  heat  again, 


126  DISEASES  OF  CHILDREN. 

with  stirring,  until  it  becomeg  quite  fluid,  and  then  suffer  it  to 
boil. 

In  the  preparing  of  the  food,  do  not  use  too  much  heat,  or 
haste,  as  it  will  prevent  the  necessary  chemical  change  taking 
place.  Use  a  gentle  heat,  and  only  allow  it  to  come  to  a  boiling 
temperature  at  the  end  of  the  process. 

In  employing  artificial  food,  whether  milk  or  that  just  named, 
it  it  better  that  it  be  given  with  a  nursing  bottle,  rather  than 
with  the  spoon.  There  is  more  than  one  reason  for  this  direc- 
tion, but  one  good  reason  is  sufficient.  The  act  of  sucking  calls 
into  use  the  muscles  connected  with  the  salivary  glands,  and  ex- 
cites those  glands,  hence  there  is  good  insalivation  of  the  food. 
Maw's  nursing  bottles  are  decidedly  the  best,  though  they  require 
more  care  to  keep  them  clean  and  in  order.  But  the  ordinary 
nursing  bottle  will  answer  if  it  is  well  looked  after. 

Milk  should  never  be  allowed  to  stand  in  the  bottle,  which 
should  be  emptied  and  rinsed  every  time  it  is  used,  and  kept  in  a 
vessel  of  water,  or  at  least  partly  filled  with  water.  In  this  way 
it  is  kept  clean  and  sweet. 

Everything  connected  with  the  food  of  the  child  should  receive 
the  greatest  care,  and  should  be  frequently  scalded. 

A  very  slight  decomposition  in  the  milk,  from  sourness  of  a 
vessel,  will  give  the  child  an  indigestion,  and  may  seriously 
derange  the  functions  of  the  stomach  and  bowels.  These  facts 
can  not  be  too  forcibly  impressed  upon  those  who  have  the 
nursing  of  children  in  this  way. 

The  food  of  the  child  should  always  be  given  at  the  tempera- 
ture of  the  body,  and  this  will  require  the  employment  of  heat  at 
all  periods  of  the  day.  A  nursery  lamp  answers  this  purpose 
very  well,  but  there  is  a  much  simpler  means  available  wherever 
coal-oil  or  gas  is  employed  for  light.  It  is  a  nursery  attachment, 
which  may  be  attached  to  any  lamp  or  gas-burner,  and  which  will 
hold  a  cup  steadily  over  the  blaze,  where  it  will  quickly  heat. 
These  are  made  by  Messrs.  Tifft  &  Howard,  406  Pearl  street. 
New  York,  of  whom  they  may  be  ordered  by  mail,  if  they  can 
not  be  obtained  nearer. 

It  seems  very  important,  when  trying  to  raise  a  child  by  the 
milk  of  the  cow,  to  be  able  to  determine  whether  the  milk  ob- 
tained is  good.  There  is  a  very  simple  method,  which  will  give 
this  information  to  any  one.  Allow  the  milk  to  stand  for  six 
hours,  skim  it,  and  if,  upon  holding  it  to  the  light,  the  skimmed 


CAHK    OK    I^■FANTS.  127 

milk  has  the  natural  color,  it  is  good.  But  if  it  is  blue,  or  green, 
or  varies  in  appearance  in  any  way,  the  milk  should  be  rejected 
as  not  fit  for  the  purpose,  and  another  cow's  milk  should  be  tried. 
I  need  not  say  that  it  is  important  that  the  child  should  have 
one  cow's  milk,  and  I  am  satisfied  that  it  is  much  better  if  the 
cow  is  fresh. 

As  the  child  attains  to  the  end  of  its  first  year,  it  will  require 
additional  food  to  the  mother's  milk.  If  it  is  strong  and  healthy 
it  may  be  gradually  accustomed  to  the  ordinary  diet  of  the 
family ;  farinaceous  food  being  preferred  to  animal.  If,  how- 
ever, the  digestive  organs  are  not  strong,  it  will  be  better  to  con- 
fine it  to  a  milk  diet,  or  to  food  prepared  with  flour  and  milk,  or 
with  sago,  tapioca,  etc. 

A  Wet  Nurse. — Next  to  the  mother's  milk  as  food  for  the 
child,  the  milk  of  another  woman  is  the  best,  and  when  a  choice 
can  be  had,  preference  should  always  be  given  to  a  wet-nurse, 
Mothers  have  a  prejudice  to  overcome  in  agreeing  to  this;  yet, 
as  it  is  manifestly  for  the  child's  benefit,  and  as  its  chances  of 
living  are  one  hundred  per  cent,  greater,  it  is  a  duty  to  make  the 
sacrifice  for  the  child's  benefit.  When  we  have  really  tried  it, 
having  a  wet-nurse  in  the  house,  and  having  the  care  of  baby, 
will  not  be  found  nearly  sq  objectionable  as  anticipated. 

The  nurse  should  be  selected  with  reference  to  her  health,  the , 
age  of  her  milk,  and  with  reference  to  her  character  aiid  associa- 
tions.    We  do  not  expect  perfection  in  a  woman  who  is  obliged 
to  take  this  position,  and  must  make  many  allowances. 

As  a  general  rule,  we  will  find  the  health  of  persons  in  the 
lower  walks  of  life  much  better  than  those  who  enjoy  more  of 
this  world's  goods  and  comforts.  The  general  appearance  of  the 
patient  will  usually  tell  the  story  at  the  first  glance.  Such  per- 
sons are  rarely  scrofulous,  at  least  to  that  extent  that  it  would  be 
objectionable,  and  if  they  are,  they  carry  the  marks  in  old  cica- 
trices, and  enlarged  glands. 

What  we  are  most  fearful  of  is  a  syphilitic  taint,'  secondary 
syphilis.  We  may  not  be  able  always  to  determine  this,  for  it 
may  exist  in  the  system,  without  having  as  yet  shown  itself  in 
the  usual  symptoms.  A  person  suffering  from  secondary  syphilis 
in  the  early  stage  will  show  macula;,  and  if  the  tongue  is  exam- 
ined we  will  find  the  evidence  in  recent  or  old  indurations. 

The  danger  of  getting  a  person  afflicted  with  syphilis  is  not 


128  DISEASES  OF  CHILDREN. 

great,  except  in  large  cities,  and  even  here  the  pleasures  and 
profits  of  a  life  of  shame  are  so  much  greater  than  attends  the 
position  of  a  wet-nurse,  that  they  are  not  frequent  applicants. 

When  there  is  doubt  of  the  capacity  of  the  applicant  to  fur- 
nish a  sufficient  supply  of  milk  for  the  child,  the  breasts  may  be 
examined.  If  round  and  firm,  of  usual  size,  and  a  well  devel- 
oped nipple,  there  will  be  but  little  doubt  in  this  respect.  It  is 
important  that  the  nipple  be  free  from  sores  or  abrasions,  as  this 
not  only  prevents  free  nursing,  but  it  is  the  source  from  which 
vices  of  constitution  are  most  frequently  transmitted. 

It  is  best  that  the  milk  of  the  wet-nurse  be  as  young  as  the 
mother's.  "When  other  things  are  right,  three  or  four  weeks,  or 
even  as  many  months,  may  be  permitted.  I  do  not  see  any  ob- 
jection to  the  milk  being  too  young,  if  it  has  passed  the  first 
week. 

As  regards  the  character  of  the  wet-nurse,  we  would  like  to 
have  it  as  good  as  possible,  as  well  as  her  associations.  Still, 
beggars  can  not  always  be  choosers;  we  want  to  save  the  life  of 
the  child,  and  wet-nurses  are  not  too  plenty,  and  we  may,  by 
kindness  and  good  offices,  improve  both  character  and  associations. 

"Weaning  the  Child. — Almost  all  the  works  that  speak  of 
weaning  the  child,  name  twelve  months  as  the  period  the  child 
should  nurse.  This,  however,  is  English  and  continental 
authority,  and  is  not  always  adapted  to  this  country  and  our 
habits.  If  a  child  is  well  developed,  and  has  cut  its  teeth  thus 
far  without  trouble,  there  is  no  reason,  so  far  as  it  is  concerned, 
why  it  should  not  be  weaned.  Of  course  it  is  essential  that  for 
a  couple  of  months  it  has  been  accustomed  to  eating,  and  has 
digested  its  food  well.  I  do  not  think  weaning  is  prudent  until 
we  have  the  conditions  named. 

If,  as  in  some  cases,  the  milk  of  the  mother  is  found  to  disa- 
gree with  the  child,  it  may  be  weaned  at  a  much  earlier  period, 
and  will  thrive  better  on  the  milk  of  the  cow,  or  the  other  foods 
named,  than  if  permitted  to  nurse.  Not  unfrequently  the  moth- 
er's milk  undergoes  a  change  from  the  eighth  to  the  fourteenth 
month,  that  renders  it  poorly  adapted  to  the  wants  of  the  child, 
and  gives  rise  to  various  symptoms  of  infantile  dyspepsia,  and  to 
irritability  of  the  bowels. 

The  re-a]>pearance  of  the  menstrual  discharge  sometimes  pro- 
duces a  very  marked  effect  upon  the  milk,  and  in  nearly  all  cases 


CAEE  OF  INFANTS.  129 

impairs  its  value.  But  as  this,  iu  the  usual  course  of  events, 
does  not  appear  until  the  child  has  attained  tl>e  age  of  one  year 
to  eighteen  months,  it  is  not  often  that  our  attention  will  be 
called  to  it.  When,  from  such  reason,  there  is  evident  change  in 
the  milk,  and  it  gives  rise  to  gastro-intestinal  or  other  disease, 
we  will  advise  weaning  the  child. 

"When  the  mother  becomes  pregnant  while  nursing,  the  milk 
very  generally  suffers  after  a  time.  It  is  necessary  in  this  case 
that  the  child  be  weaned,  not  only  for  its  own  sake,  but  for  the 
mother's;  for  nursing  a  child  would  interfere  with  the  natural 
progress  of  gestation. 

The  objections  to  weaning  the  child  are  of  two  kinds — with 
reference  to  the  mother,  and  with  reference  to  the  child.  The 
first  objection  would  seem  trivial,  if  we  did  not  so  often  witness 
the  health  of  the  mother  completely  broken  down  by  frequent 
child-bearing.  It  is  the  popular  impression,  and  to  some  extent 
it  is  true,  that  so  long  as  a  woman  nurses  her  child,  she  will  not 
have  her  menstrual  periods,  and  so  long  she  will  not  be  in  dan- 
ger of  becoming  pregnant.  Frequent  pregnancies  are  a  very 
great  burden  to  a  woman,  especially  if  she  has  not  the  proper 
assistance  in  the  care  of  her  family,  and  we  need  not  wonder 
that  she  prefers  to  nurse  one  child  for  two  or  three  years,  rather 
than  have  another  added  to  her  cares. 

The  objections  upon  the  part  of  the  child  are  with  reference 
to  its  health,  and  its  powers  of  digestion  and  assimilation  in  main- 
taining a  separate  existence.  In  some  families  every  child  has 
to  pass  through  a  second  summer  of  cholera  infantum,  which 
requires  great  care,  especially  with  regard  to  its  food.  In  such 
cases  it  is  best  for  the  child  to  nurse  eighteen  months,  or  even 
two  years. 

In  other  cases  the  infant  is  far  from  robust,  and  its  develop- 
ment is  slow ;  it  cuts  its  teeth  tardily,  does  not  digest  food  well, 
and  is  liable  to  attacks  of  gastro-intestinal  irritation.  Here, 
also,  nursing  the  child  should  be  prolonged. 

When  it  is  determined  to  wean  the  child,  there  is  much  dis- 
cussion of  how  it  is  to  be  done,  as  it  is  no  easy  matter  in  many 
cases,  and,  as  usually  managed,  very  troublesome  in  most. 

Trying  to  "  taper  off,"  as  a  drunkard   tries  to  quit  drinking, 

giving  the  child  a  little  now  and  then,  or  depriving  him  of  it  in 

the  day-time,  giving  it  to  him  at  night,  is  just  about  as  efficient 

in  the  one  case  as  in  the  other.     At  the  end  of  a  week  the  child 

9 


130  DISEASES  OF    CHILDREN. 

is  no  nearer  weaned  than  when  it  commenced ;  but  in  most  cases 
is  farther  from  it,  for  it  has  been  worried  and  tantalized  until  it 
has  a  stronger  desire  for  the  breast  than  before  the  weaning 
commenced. 

It  is  also  a  poor  plan  to  put  bitter  or  nauseous  things  on  the 
nipple,  thinking  to  disgust  the  child,  and  make  it  reject  the 
breast.  While  it  answers  occasionally,  it  fails  in  the  majority  of 
cases.  It  is  objectionable,  also,  because  it  makes  a  bad  impres- 
sion upon  the  child's  mind,  and  it  feels  that  it  has  been  deceived, 
and  wronged. 

The  only  true  way  is,  to  stop  giving  the  breast  at  once,  and 
convince  the  child  that  this  is  right.  In  the  day  there  will  be 
but  little  trouble,  and  if  the  father  or  some  friend  will  take  care 
of  the  child  for  two  or  three  nights,  the  trouble  will  be  all  over. 
The  moral  effect  of  such  a  course  upon  the  child  will  be  a  decided 
benefit,  and  will  give  the  mother  a  power  of  control  that  she 
could  not  otherwise  possess. 

Sleeping. — The  young  child  should  be  accustomed  to  regular 
periods  of  sleep  during  the  day,  indeed,  all  its  habits  should 
have  great  regularity.  As  it  grows  older  it  does  not  need  so 
much  sleep,  and  after  it  has  passed  its  first  year,  it  will  not 
usually  require  more  than  one  sleep  in  the  day-time. 

At  night  the  child  should  have  its  separate  bed.  I  think  it 
very  objectionable  for  the  child  to  sleep  with  its  parents.  Expe- 
rience has  proven  that  the  young  yield  vitality  to  the  older,  and 
the  sound  to  the  unsound.  This  would  be  a  very  cogent  reason 
if  either  of  the  parents  suffered  from  ill  health.  But  beyond  this 
it  is  not  well  for  the  child  to  breathe  the  emanations  from  the 
bodies  of  other  persons,  as  it  must,  if  thus  confined,  and  fre- 
quently covered  so  as  to  almost  exclude  the  air. 

Another,  and  a  very  important  reason  is,  that  if  allowed  to  lie 
with  the  mother  all  night,  it  will  obtain  a  habit  of  frequent 
nursing  that  will  prove  detrimental  to  its  own  health  and  to  the 
health  of  the  mother.  Many  times  an  infantile  dyspepsia  may 
be  traced  to  this  source. 

Let  the  child  lie  in  its  crib  or  cradle  at  the  bedside,  and  when 
it  requires  nursing  the  mother  can  take  it  in  the  bed  with  her 
and  give  it  the  breast,  placing  it  in  the  cradle  again  afterward. 
A  child  cared  for  in  this  way  will  be  much  less  trouble  to  the 
mother,  in  addition  to  the  advantage  to  its  own  health. 


CARE   OP   INFANTS.  131 

Regular  Habits. — There  are  few  persons  that  can  be  con- 
vinced how  readily  a  child  may  be  trained  to  regular  habits,  in 
all  things,  unless  they  have  seen  it.  Very  frequently  they  will  not 
believe  the  evidence  of  their  own  eyes,  but  account  for  it  by 
saying,  that  it  is  owing  to  a  difference  in  children,  some  being 
good,  others  being  bad.  The  truth  is,  that  a  child  is  just  as 
sensible  to  impressions  as  the  adult,  and  is  just  as  ready  to  yield 
obedience  if  it  is  asked  in  a  proper  manner.  Beyond  this  is  the 
fact,  that  habits  in  childhood  are  very  readily  formed,  and  very 
persistently  maintained.     This  is  as  true  of  bad  habits  as  of  good. 

During  the  first  three  months  the  child  should  be  accustomed 
to  taking  the  breast  about  every  three  hours,  and  at  very  regular 
intervals.  As  it  grows  older  it  will  not  require  it  more  than 
four  times  during  the  day,  and  once  at  night.  One-half  the 
slight  illnesses,  and  the  irritability  and  fretfulness  of  childhood 
might  be  avoided  in  this  way. 

Nursing  the  child  whenever  it  cries,  simply  to  keep  it  quiet,  is 
a  most  pernicious  habit,  and  will  very  certainly  lead  to  ill  health, 
usually  in  the  form  of  infantile  dyspepsia  and  colic.  And  yet 
this  is  a  very  common  habit,  and  will  require  much  effort  upon 
the  part  of  the  mother  to  break  it  up. 

The  time  of  getting  up  in  the  morning,  of  being  washed  and 
dressed,  of  taking  the  morning  sleep,  of  the  afternoon  sleep, 
should  all  be  as  regular  as  the  clock.  I  know  that  the  physician 
will  be  met  by  many  objections  when  he  urges  this ;  the  most 
common  being,  that  the  mother  has  other  duties  besides  taking 
care  of  her  child,  and  the  attention  it  requires  can  not  always  be 
given  at  the  minute.  The  fact  is,  however,  that  duties  regularly 
performed  become  light  by  the  side  of  those  irregularly  done. 
No  one  ever  accomplishes  much,  unless  the  work  is  pursued  by 
system.  So  in  this  case,  it  is  a  saving  of  time  to  do  things 
promptly  to  the  minute,  and  have  the  child  in  good  humor  and 
take  its  long  refreshing  sleeps,  rather  than  from  neglect,  to  have 
it  irritable  and  fretful,  difficult  to  get  to  sleep  and  hard  to  keep 
asleep. 

There  is  no  necessity  of  rocking  a  child  when  sleeping,  indeed 
but  little  necessity  of  their  being  rocked  at  any  time.  If  they 
are  accustomed  to  go  to  sleep  at  a  certain  time,  all  that  is  required 
is  to  give  them  the  breast,  and  put  them   in  the  crib  or  the  bed. 

Americans  might  learn  a  valuable  lesson  from  our  German 
citizens,  in  regard  to  the  management  of  young  children.     They 


132  DISEASES   OF   CHILDREX. 

put  them  in  the  crib  and  cradle  and  cover  them  warmly,  and 
keep  them  there,  except  when  nursed.  There  seems  to  be  no 
trouble  about  it,  the  child  is  comfortable,  is  accustomed  to  that 
method  of  living,  and  takes  it  as  quietly  as  if  it  were  its  natural 
mode  of  existence.  When  it  becomes  old  enough  to  play,  a 
tassel,  with  some  simple  toys,  is  suspended  within  reach  of  its 
hands,  and  with  them  it  will  amuse  itself  for  hours  at  a  time. 
When  old  enough  to  sit  alone,  it  is  accustomed  to  amuse  itself  in 
a  similar  way. 

MORAL  GOVERNMENT. 

As  the  health  of  the  child  will  depend  to  a  considerable  extent 
upon  the  condition  of  the  nervous  system,  especially  of  the  brain, 
the  physician  will  frequently  have  to  give  the  mother  instructions 
in  regard  to  its  moral  government ;  especially  will  this  be  the 
case  when  the  child  is  suffering  from  chronic  disease,  which  is 
aggravated  by  irritability,  displays  of  temper,  and  the  various 
cryings  and  frettings  so  common  in  badly-regulated  households. 
True,  in  these  cases  he  is  not  able  to  effect  as  much  by  good 
advice  as  he  would  like ;  yet,  there  are  other  cases  in  which  he 
may,  by  a  few  judicious  words  of  counsel,  direct  the  mother,  who 
is  willing,  how  to  train  her  child,  so  as  to  conduce  to  her  happi- 
ness as  well  as  its  own. 

In  this  respect,  the  experience  of  a  mother  has  higher  value 
than  any  other  person,  and  I  will  give  the  short  chapter  from 
Chambers'  Infant  Treatment,  by  the  lady  editor  of  that  work : 

"  During  the  first  few  weeks  of  life,  happiness  is  solely  derived 
from  the  healthy  operation  of  the  bodily  functions.  Until  the 
senses  begin  to  act  so  as  to  convey  impressions  to  the  brain,  there 
can  be  no  pleasure  drawn  from  external  circumstances.  The 
activity  of  the  senses,  and  the  enjoyment  produced,  will  be  in 
proportion  to  the  state  of  the  health.  An  infant  who  is  continu- 
ally in  pain,  either  crying,  moaning,  or  in  a  state  of  repletion,  or 
of  exhaustion  from  the  consequences  of  suffering,  will  be  but  little 
attracted  by  the  light,  sound,  or  motion  which  first  engages  the 
senses  of  infancy.  In  no  other  instance,  perhaps,  are  the  influ- 
ences of  the  physical  condition  so  immediate  and  so  evident.  An 
infant,  even  of  three  weeks  old,  will  exhibit  a  haggard,  grief- worn 
countenance,  sunken  eyes  and  shrunken  face,  painful  to  those 
whose  experience  tells  them  what  these  signs  indicate.     But  the 


CAEE  OF  INFANTS.  133 

fair,  plump,  contented  look  of  the  healthy  babe,  speaks  a  lan- 
guage of  comfort,  prophetic  of  the  approaching  dawn  of  intellect. 

"  The  general  irritability  caused  by  disordered  functions,  ren- 
ders the  impressions  upon  the  senses  even  more  painful  than 
pleasurable;  the  disposition  for  enjoyment  bestowed  by  the  feel- 
ing of  health  is  denied ;  the  mother's  voice,  her  smile,  are  asso- 
ciated with  pain  as  much  as  with  pleasure,  and  the  affections  are 
imperfectly  and  tardily  aroused.  As  weeks  pass  on,  habits  form, 
and  instead  of  a  habit  of  contentment,  there  is  one  of  fretful ness. 
An  infant  so  constituted  is  either  reared  with  an  indiflference  to 
its  continual  crying  and  fretfulness,  or  with  the  apprehension 
which  causes  its  nurse  to  be  continually  seeking  how  she  may 
quiet  or  prevent  its  cries.  At  the  age  when  food  alone  appeases 
it,  the  babe  is  always  eating  or  sucking ;  as  it  grows  older,  sugar, 
cake,  etc.,  are  superadded,  with  the  addition  of  noises  or  rough 
exercise,  and  but  too  frequently  some  sedative  or  composing 
draught,  which  the  mother  believes  herself  obliged  to  adopt  in 
order  to  procure  the  child  needful  repose,  or  the  servant  surrep- 
titiously administers  to  relieve  herself  from  incessant  fatigue. 
When  the  time  arrives  that  restraints  and  guidance  should  be 
adopted,  the  fear  of  farther  irritation  by  contraction  leads  to  a 
system  of  bribes,  deceit,  and  coaxing ;  all  the  lowest  sentiments 
of  human  nature  are  appealed  to ;  and  at  two  years  old  we  have 
a  selfish,  willful,  ill-tempered  child,  with  violence  apportioned  to 
its  strength,  and  intelligence  prompted  by  ill  feelings.  It  is  not 
to  be  supposed  that  these  moral  disorders  belong  exclusively  to 
bad  health.  A  healthy  child  may  be  selfish,  willful  and  ill- 
tempered  at  two  years  of  age,  if  injudicious  treatment  have 
cultivated  the  lower  sentiments ;  but  the  healthy  infant  is  predis- 
posed to  receive  happy  impressions,  and  enjoys  the  condition 
called  good  temper — a  term  which  in  infancy  is  synonymous  with 
good  health.  The  nurse  has  fewer  temptations  to  mismanagement, 
and  the  affections  and  intelligence  being  more  healthful  and  active, 
moral  mismanagement  actually  produces  less  permanent  injury. 

"There  can  not,  then,  be  too  much  value  attached  to  the 
physical  condition  of  an  infant ;  to  the  condition  of  the  parent 
while  pregnant  and  while  nursing,  and  to  the  regulation  of  every 
particular  connected  with  the  health  of  her  offspring.  This 
being  the  first  object,  both  in  point  of  time  and  importance,  the 
next  consideration  is  the  means  of  developing  the  moral  and 
intellectual  faculties." 


Pj^HT   III. 

DISEASES  OF  CHILDHOOD. 

CHAPTER    IV. 

The  diseases  of  childhood  do  not  differ  in  their  pathology 
from  the  diseases  of  the  adult.  In  each  disease,  there  is  a  de- 
pression of  the  vitality,  either  of  the  whole  or  of  a  part,  and 
though  there  may  be  increased  functional  activity  in  some  par- 
ticular functions  or  part,  we  must  never  take  it  as  an  indication 
of  an  increased  vitality  or  of  a  real  functional  increase. 

The  animal  body  in  early  life  is  immature  in  all  its  parts,  and 
■what  change  there  may  be  in  the  character  of  diseased  action,  is 
in  part  dependent  upon  this.  The  tenacity  to  life  is  just  as 
strong  in  the  child,  in  many  cases  even  stronger  than  in  the 
adult.  Possibly,  this  increased  tenacity  of  life,  will  counter- 
balance the  immaturity  of  organs,  in  all  children  who  possess 
vitality  sufficient  to  reach  adult  years. 

There  is  this  fact  to  be  taken  into  consideration  in  all  our 
estimates  of  infantile  disease:  That  there  is  a  certain  proportion 
of  children,  who  are  not  born  with  sufficient  vitality  to  live 
longer  than  the  second  year,  and  some,  indeed,  who  have  not  the 
capacity  to  live  this  long. 

It  is  not  worth  our  while  here  to  discuss  to  any  considerable 
length  why  this  is  so,  but  it  concerns  us  to  know  that  it  is  a  fact, 
and  to  know  how  we  may  determine  it. 

It  is  a  well-known  fact  in  vegetable  physiology  that  imperfect 
or  unsound  seed  will  not  produce  perfect  plants ;  and  that  when 
the  seed-bearing  plant  requires  to  be  fertilized  by  the  pollen  of 
another,  an  unsoundness  of  this  will  lead  to  deterioration  ;  that 
in  breeding  animals,  sound  and  robust  young  are  not  expected 


PHYSIOLOGICAL  MARRIAGE.  135 

from  immature  or  unhealthy  parents  ;  and  that  peculiarities  and 
imperfections  will  be  increased  from  generation  to  generation,  by 
propagating  from  animals  thus  impaired. 

In  our  civilization  there  is  a  continual  breeding  in,  with  refer- 
ence to  physical  and  vital  imperfections,  and  hence  to  save  the 
integrity  of  the  species,  it  is  necessary  that  the  imperfect  young 
should  die  before  they  have  arrived  at  an  age  to  transmit  their 
physical  imperfections. 

Physiological  Marriage. — Prof.  William  Byrd  Powell 
advanced  the  theory,  that  persons  of  similar  temperaments  could 
not  have  healthy  offspring,  or  in  some  cases,  would  not  be  capa- 
ble of  begetting  children ;  even  two  very  healthy  persons,  physi- 
cally and  mentally  well-developed,  and  with  each  the  capacity  to 
live  the  allotted  time  of  man,  might  have  children  that  would  not 
live  to  the  age  of  two  years,  or  in  some  cases  would  not  have  the 
capacity  for  independent  existence  at  all. 

The  principles  of  this  discovery,  if  discovery  it  is,  are  thus 
briefly  stated  by  Prof.  Powell : 

"  Law  I.  When  the  constitutional  similitude  of  the  respective 
sexes  is  such  that  a  qualified  observer  can  not  detect  an  appre- 
ciable difference,  sterility  will  be  the  result  of  their  marriage. 
Illustration :  Washington  and  his  wife  were,  respectively,  san- 
guine, and  it  is  known  that  sterility  was  the  result.  Between 
General  Jackson  and  his  wife  there  was  a  nominal  difference  of 
constitution;  he  was  bilious  sanguine,  and  she  was  bilious; 
nevertheless  they  were  physically  the  same,  both  being  exclu- 
sively vital,  and  it  is  known  that  sterility  was  the  result.  The 
first  Napoleon  and  Josephine  were,  in  person,  greatly  different, 
and  in  constitution  they  were  nominally  as  different,  and  yet 
there  was  no  physiological  difference.  He  was  sanguine  enceph- 
alo-bilious  lymphatic,  and  she  was  bilious  encephalic,  conse- 
quently they  w^ere,  respectively,  compounded  of  equal  varieties 
of  vital  and  non-vital  conditions,  and  it  is  known  that  sterility 
was  the  result  of  their  alliance. 

"  Law  it.  When  the  constitutional  similitude  of  the  respec- 
tive sexes  is  less  than  complete,  or  is  appreciably  different, 
progeny  will  result,  but  it  will  be  dead-born,  imbecile,  scrofulous, 
deaf,  blind,  or  otherwise  imperfect.  Illustration:  I  can  furnish 
three  hundred  examples  of  this  law,  but  as  they  are  not  histori- 


136  DISEASES   OF   CHILDREN. 

cally  kuown,  they  would  be  of  no  value  in  this  relation.  I  can 
cite  one,  however,  which  is  historically  known,  viz. :  the  first 
Napoleon  and  his  second  wife.  Her  temperament  was  bilious 
encephalo-sanguine,  and  his  temperament  I  have  indicated. 
There  was  between  them  an  appreciable  difference  of  constitu- 
tion, and  the  result  of  this  difference  was  one  son  ;  but  the  dif- 
ference was  too  small  to  secure  to  him  a  normal  viability,  for  he 
died  of  a  scrofulous  affection  of  the  lungs,  at  the  age  of  eighteen 
years.  •  It  is  most  indisputably  the  fact,  that  a  considerable  differ- 
ence of  constitution  must  obtain  between  the  respective  parties 
to  a  marriage,  to  secure  to  offspring  a  soundly  viable  constitu- 
tion. To  discover  the  least  difference  consistent  with  a  physiolo- 
gical marriage  was  indispensible,  but  before  discovering  this  the 
conviction  became  forced  upon  me  that  my  discovery  could  not 
become  of  general  utility  without  the  discovery  of  a  law  of 
universal  application.  By  a  great  amount  of  observation  and 
study,  I  succeeded  in  discovering  the  desired  law,  and  it  is  of 
easy  application,  and  will  universally  secure  a  physiologically 
legitimate  offspring,  and  the  greatest  possible  happiness  to  the 
parents.  Those,  therefore,  who  make  domestic  happiness,  and  a 
really  useful  progeny,  conditions  of  marriage,  must  observe  the 
following  law : 

"  Law  III.  One  of  the  parties  must  be  exclusively  vital— that 
is,  must  be  either  sanguine,  bilious,  or  sanguine-bilious  (the  last 
being  a  compound  of  the  two  former,  is  also  vital),  and  the 
other  party  must  as  certainly  be  more  or  less  non- vital,  that  is, 
more  or  less  lymphatic  or  encephalic.  All  marriages,  in  contra- 
vention of  this  law,  are  physiologically  incestuous,  and  the  con- 
sequences will  be  vicious  in  proportion  to  the  delinquency. 

"  Law  IV.  The  greatest  dissimilitude  of  constitution  that  can 
obtain  between  the  sexes,  when  they  are  respectively  of  the  same 
species,  is  that  which  obtains  between  a  vital  and  a  non-vital 
temperament — and  this  is  the  most  favorable  to  progeny.  But 
marriages  of  this  character  are  greatly  impracticable  in  any 
country.  It  is  a  very  remarkable  fact  in  the  physiology  of  hu- 
man procreation,  that  a  high  degree  of  constitutional  dissimil- 
tude  is  about  equally  unfavorable  to  progeny.  It  has  been  seen 
that  a  high  degree  of  similitude  entails  a  scrofulous  diathesis,  and 
with  a  high  degree  of  dissimilitude,  as  when  one  party  is  white  and 
the  other  negro,  the  progeny  is  invariably  scrofulous,  I  believe." 


TEMPERATURE,  ETC.  137 

Life  Line. — To  determine  whether  a  child  has  the  power  to 
live  to  adult  years,  is  of  much  moment  if  it  is  practicable.  Most 
persons  judge  by  the  general  appearance,  and  by  the  functional 
activity  of  the  important  organs.  A  physician  in  active  practice 
for  a  number  of  years,  will  be  able  to  form  a  very  good  opinion 
in  most  cases,  but  will  occasionally  be  seriously  in  error. 

I  have  been  accustomed  to  place  much  reliance  upon  a  meas- 
urement of  the  base  of  the  brain,  which  determines  its  depth. 
Let  the  meatus  auditorius  externus  represent  the  floor  of  the 
cranium,  which  it  does  only  approximately,  and  a  line  drawn 
from  the  occipital  protuberance  to  the  external  angular  process 
of  the  os-frontis  where  it  articulates  with  the  malar  bone,  repre- 
sent the  superior  part  of  the  basilar  brain,  as  marked  by  the 
tentorium  cerebelli.  The  measurement  between  the  two  is  approxi- 
mately the  depth  of  the  base  of  the  brain. 

If  the  measurement  is  one-half  inch  or  more,  the  child  has 
the  capacity  to  live  to  adult  years,  and  will  pass  safely  through 
any  ordinary  sickness.  If  tlie  measurement  is  from  three-fourths 
of  an  inch  to  an  inch,  it  will  live-  when  it  would  seem  hardly 
possible.  But  if  the  life  line  fall  below  the  measurement  of  one- 
half  inch,  the  power  of  living  is  feeble,  and  the  child*  will 
succumb  to  the  slightest  ailments,  and  with  one-fourth  or  even 
one-third  of  an  inch,  we  may  safely  say  that  life  is  not  possible. 

As  a  physician's  success  will,  to  a  certain  extent,  depend  upon 
his  powers  of  prognosis,  such  knowledge  as  this  will  prove  of 
ranch  importance.  It  tells  us  when  we  may  rely  on  treatment 
to  eifect  recovery,  and  when  the  best  treatment  will  fail  of  success. 

For  the  general  pathology  of  disease,  and  the  principles  upon 
which  we  base  our  practice,  the  reader  is  referred  to  my  "  Prin- 
ciples of  Medicine." 

TEMPERATUKE.    PULSE.    RESPIRATION. 

In  an  abnormal  condition  of  the  system,  the  first  things  to  be 
considered  are,  the  temperature,  pulse  and  respiration.  Pulse 
and  respiration  are  more  readily  affected,  and  to  a  greater  extent, 
than  the  temperature,  but  the  latter  affords  a  more  correct  diag- 
nosis of  the  patient's  condition  than  the  former.  The  pulse  may 
deviate  from  a  healthy  standard,  from  some  trivial  cause  as  that 
of  anger,  slight  indigestion,  and  sometimes  sleep  will  produce  a 
change,  but  under  such  circumstances  the  trouble  will  be  of  no 


138  DISEASES  OF  CHILDREN. 

moment  and  soon  subside.  However,  should  a  change  of  tem- 
perature occur  and  remain  for  a  time,  a  general  abnormal  condi- 
tion will  prevail.  Too  much  importance,  then,  can  not  be  attached 
to  the  study  of  the  temperature,  and  a  thorough  knowledge  in 
disease  of  the  body  thermoneter. 


TABLE 

Showing  the  Temperature,  Pulse  and  Respiration  at  variotis  Ages. 

PULSE. 

RESPIRATION. 

Temperature  above  normal  age,  at  birth,  1.5 

1st  month,  .5 
1st  year,      .25 
15th  year.  .21 
21st  year,    .0 

120  to  150 
120 

105  to  130 
75  to  85 
70  to   75 

40  to  60 
40 

30  to  40 
20 

16  to  18 

Deviations  from  this  table  have  been  found  without  any  con- 
stitutional disturbance,  but  they  were  few,  and  so  far  as  tests  have 
extended  it  is  accurate. 

Temperatuee. — Exercise  and  diet,  as  well  as  climate,  may 
affect  and  cause  the  temperature  to  vary,  but  it  will  be  but  a  tem- 
porary change  when  thus  disturbed.  Should  it,  however,  deviate, 
and  remain  so  for  some  hours,  we  may  expect  an  abnormal  con- 
dition of  the  system.  If,  on  the  day  following  we  note  an  in- 
crease in  the  temperature,  running  as  high  or  higher  than  that  of 
the  day  preceeding,  the  question  of  disease  is  beyond  all  doubt. 
In  measles  there  is  usually  a  high  temperature  three  or  four  days 
preceding  the  eruption  ;  in  scarlet  fever  it  is  less  a  day,  perhaps; 
in  variola  two  days;  in  whooping-cough,  the  first  indication  of 
the  disease  is,  a  change  in  temperature  usually  running  quite 
high  ;  in  diphtheria  it  precedes  the  soreness  of  throat.  Increase 
of  temperature  calls  for  sedatives  and  cooling  remedies.  Decrease 
of  temperature  demands  stimulants  and  sustaining  treatment. 
The  following  things  are  to  be  taken  into  special  consideration : 
The  hour  at  which  the  temperature  rises  or  falls.  An  increase 
of  temperature,  beginning  a  little  earlier  each  day,  is  cause  for 
alarm,  beginning  later  is  encouraging.  A  decrease,  beginning 
earlier  each  day  is  a  good  indication,  beginning  later,  it  is  to  be 
closely  watched ;  also  the  duration  of  temperature.  Should  a 
high  temperature  prevail  and  remain  without  a  decline  for  some 
time,  it  is  to  be  regarded  as  very  unfavorable.  Likewise  a  low 
temperature,  remaining  so  for  a  time  or  continuing  to  decrease, 
is  to  be  considered  a  most  dangerous  symptom,  being  of  greater 
danger  than  a  corresponding  rise  would  be — the  danger   lying 


TEMPERATURE — PULSE.  139 

in  the  great  depression,  and  probable  want  of  vital  force  neces- 
sary to  accomplish  a  reaction.  The  daily  fluctuations  of  tem- 
perature should  be  carefully  noted,  going  frequently  from  one 
point  to  another,  and  not  remaining  stationary  any  given  time. 
The  food  of  the  child  has  an  influence  on  the  temperature ;  after  a 
good  nourishing  meal,  there  will  be  a  rise  in  the  index  of  the 
thermometer ;  if  there  is  no  rise,  the  food  does  not  contain 
sufficient  nourishing  properties.  This  rise  will  not  exceed  .5, 
unless  in  a  case  neariug  starvation,  when  it  may  be  increased. 
A  too  simulating  food  will  produce  a  rise  of  one  degree  in  the 
temperature ;  after  digestion  there  will  be  a  decrease  of  temperia- 
ture  until  the  normal  standard  is  reached. 

Pulse. — As  previously  said  the  pulse  is  more  easily  disturbed 
than  the  temperature,  and  an  increase  may  be  occasioned  by  the 
most  trivial  cause.  The  position  of  the  body  influences  the 
pulse,  it  being  augmented  when  the  body  is  in  a  standing  posi- 
tion, and  decreased  when  lying  down.  Joy,  grief  and  anger  will 
vary  the  pulsations  of  the  body  ;  food  likewise  affects  it.  Hence, 
an  accelerated  pulse  must  not  always  be  regarded  with  alarm ; 
but  when  such  a  condition  supervenes  with  general  constitutional 
disturbance,  it  demands  investigation.  In  studying  the  pulse  we 
want  to  note  the  frequency,  regularity  and  fullness.  Referring  to 
the  table  we  find  that  in  a  healthy  adult  there  are  from  70  to  75 
pulsations  per  minute  ;  we  note  the  fact  on  the  living  body,  and 
finding  it  to  correspond,  we  next  observe  the  regularity,  whether 
the  pulsations  are  uniform  in  volume  and  time,  or  whether  there 
is  an  iri'egular  action  of  the  heart,  causing  the  pulse  to  intermit. 
Fullness  of  pulse  is  ascertained  by  the  sensation  imparted  to  the 
finger  from  the  current  of  blood  as  it  passes  through  the  artery. 
If  a  large  portion  of  the  pulsation  is  felt,  we  get  fullness,  but  if 
the  finger  discovers  but  a  small  portion  of  it  we  have  the  reverse; 
likewise  we  detect  a  hard  pulse,  soft  pulse,  and  a  wiry  pulse,  and 
measure  them  according  to  the  standard  of  increase,  decrease  and 
perversion.  With  children  it  is  more  difficult  to  obtain  accu- 
rately the  number  of  pulsations  to  the  minute,  but  the  general 
character  of  the  pulse  is  to  be  taken  into  consideration  in  order 
to  determine  the  departure  from  a  normal  condition.  If  possible 
observe  the  pulse  while  the  child  is  sleeping.  The  pulsations 
will  be  more  accurate  than  when  the  little  sufferer  is  awake  and 
irritable. 


140  DISEASES   OF    CHILDREN. 

Respiration. — In  disease  we  not  only  desire  to  know  the 
number  of  respirations  per  minute,  whether  there  is  an  increase 
or  decrease,  but  we  must  as  fully  understand  the  character  and 
source  of  respiration ;  whether  it  occurs  with  regularity,  or 
whether  it  is  panting  and  short;  whether  it  is  abdominal  or 
thoracic,  and  whether  a  full  inspiration  can  be  taken  without 
causing  pain.  Note,  if  any,  the  difference  in  the  character  of 
respiration  when  the  child  is  sleeping  and  when  awake ;  also  the 
sounds,  if  any,  produced  by  respiration.  Observations  made 
during  sleep  are  generally  more  accurate  than  made  when  the 
child  is  awake,  as  any  exertion  quickens  the  respiration. 

CLASSIFICATION  OF  DISEASE. 

It  is  most  convenient,  and  at  the  same  time  the  most  suc- 
cessful plan  to  study  disease  as  it  influences  particular  parts 
or  functions.  We  thus  get  all  the  diseases  of  a  part  in  a  group, 
and  are  able  to  learn  better  the  differential  diagnosis  between 
them,  and  also  between  them  and  others  of  different  parts. 

There  are  certain  diseases  that  are  general  in  their  character, 
and  have  their  cause  principally  in  the  blood,  or  in  functions 
intimately  associated  with  it — as  blood-making,  nutrition,  and 
retrograde  metamorphosis.  This  will  naturally  form  the  first 
division. 

We  may  then  study  diseases  of  the  digestive  organs  in  a  group, 
next,  diseases  of  the  respiratory  organs,  then  diseases  of  the 
kidneys,  of  the  skin,  of  the  locomotive  apparatus,  of  the  nervous 
system,  and  of  the  organs  of  special  sense. 


CHAPTER    V. 
FEBRILE  DISEASES. 


Fever  is  a  disease  involving  to  a  greater  or  less  extent  every 
function  of  the  body.  Continuing  for  a  time,  it  impairs  the 
tissues,  in  some  cases  to  such  an  extent  that  the  further  continu- 
ance of  life  is  impossible. 

The  functional  derangement  is  studied  by  the  rule  of  excess, 
defect  and  perversion,  though  in  all  cases  the  change  is  in  reality 
an  impairment,  and  is  associated  with  depression  of  vitality. 


FEBRILE   DISEASES.  141 

In  analyzing  a  simple  fever,  we  find  it  composed  of:  1st.  An 
excess  in  the  frequency  of  the  pulse,  an  excess  in  the  temperature 
of  the  body,  and  an  excess  of  innervation.  2d.  A  defect  of  excre- 
tion by  the  skin,  the  kidneys,  and  the  bowels,  and  a  defect  of 
digestion,  assimilation  and  nutrition.  3d.  A  perversion  of  the 
blood  and  of  some  functions. 

Pathology  of  Fever. — The  doctrine  of  the  humoralist  that 
fever  is  a  disease  of  the  blood,  offers  the  best  explanation  of  the 
phenomena  of  fever,  and  leads  to  the  most  certain  methods  of 
treatment.  We  must  not  forget,  however,  that  with  such  de- 
rangement of  function,  especially  of  waste  and  excretion,  and  its 
complement  nutrition,  the  solids  of  the  body  are  being  diseased 
from  day  to  day. 

In  some  fevers,  the  cause  of  the  disease  has  been  influencing 
the  functions  of  nutrition  and  waste  for  a  considerable  time 
before  the  outbreak  of  the  fever,  and  during  this  time  all  the 
tissues  which  have  been  formed  are  more  or  less  diseased.  In 
such  a  fever,  complete  recovery  does  not  take  place  until  all  such 
tissue  is  removed.  Thus,  in  typhoid  fever,  we  find  the  disease 
continuing  until  the  soft  tissues  have  been  removed  to  a  very 
considerable  extent;  and  in  those  exceptional  cases,  where  the 
patient  does  not  lose  flesh  during  the  progress  of  the  disease,  a 
perfect  recovery  does  not  take  place;  the  reason  is  obvious — the 
imperfect  tissues  remain  in  their  place,  and  to  that  extent  the 
nutritive  process  fails.  The  old  tissue  is  incapable  of  functional 
activity,  and  hence  the  imperfection  with  which  all  the  processes 
of  life  are  performed. 

If  we  regard  the  cause  of  fever,  as  acting  in  and  from  the 
blood,  as  consisting  of  some  morbid  material,  either  generated 
within  the  body,  or  introduced  from  without,  but  always  acting 
to  impair  the  quality  of  this  fluid,  and  consequently  depressing 
every  functional  activity,  we  have  a  plain  and  very  simple 
pathology.  We  can  readily  see  how  such  condition  of  the  blood 
should  occasion  thedisturbanceof  the  circulation  that  we  witness, 
and  liow  this  abnormal  circulation  should  be  the  cause  of  the 
diminished  functional  activity  of  every  part  of  the  body. 

Based  upon  this  view  of  the  pathology  of  fever,  the  treatment 
becomes  also  simple  and  straight-forward.  The  rapid  but  im- 
perfect circulation  of  the  blood  is  corrected  by  certain  special 
medicines,  called  sedatives.     The  excretory  organs  can  then  be 


142  DISEASES  OF  CHILDEEX. 

stimulated  by  remedies  that  act  directly  upon  them  to  increased 
activity,  and  any  morbid  material  thus  removed.  We  are  then 
in  a  position  to  call  the  digestive  organs  into  action,  and  obtain 
normal  nutrition  of  tissue.  Lastly,  we  have  a  class  of  remedies 
which  directly  influence  zymotic  processes  and  products,  and  in 
some  cases  at  least,  are  antidotal  to  the  cause  of  disease.  In 
other  words,  they  are  agents  which,  when  introduced  into  the 
blood,  combine  with  and  modify  or  destroy  all  those  activities 
which  are  unnatural  to  and  not  under  the  control  of  the  vital 
forces. 

As  before  remarked,  we  must  not  lose  sight  of  the  structural 
changes  which  go  on  during  the  incubation  and  progress  of  the 
fever,  and  which  impair  the  integrity  of  the  tissues.  But  the 
treatment  for  this  is  as  distinct  as  for  the  other.  This  imperfect 
tissue  must  be  removed,  and  the  nutritive  process  must  be  stimu- 
lated to  its  repair.  The  remedies  which  increase  excretion  favor 
retrograde  metamorphosis,  and  the  two  go  on  together.  A  tonic 
and  restorative  treatment,  with  a  good  diet,  completes  the  treat- 
ment, and  the  two  go  on  harmoniously  together.  As  the  old 
tissue  is  removed  by  the  first,  new  material  is  prepared,  and 
formed  into  tissue  in  its  place  by  the  second  means.  We  have 
thus,  as  Dr.  Chambers  tersely  expresses  it,  a  real  "  renewal  of 
life." 

Classification  of  Fevers. — We  may  divide  the  fevers  of 
childhood  into  four  varieties.  The  evanescent,  or  febricula ;  the 
periodic  or  malarial  fevers,  divided  into  two  varieties,  intermit- 
tent and  remittent ;  continued  fever,  and  the  eruptive  fevers. 

FEBKICULA. 

Occupying  a  prominent  place  in  the  diseases  of  childhood,  if  we 
regard  the  percentage  of  cases,  is  this  little  fever.  I  call  it  little 
on  account  of  its  brief  duration,  and  the  little  danger  that 
attends  it.  In  the  apparent  symptoms  it  may  be,  and  frequently 
is,  a  very  high  or  active  fever,  and  gives  rise  to  much  uneasiness 
on  the  part  of  parents. 

Causes. — The  causes  of  febricula  are  numerous,  but  why  they 
influence  the  system  in  this  way  is  not  well  known.  Probably, 
the  most  frequent  cause  is  the  action  of  cold  arresting  secretion 
from  the  skin.     The  similar  arrest  of  secretion  from  the  kidneys 


PHYSIOLOGICAL  MA.RKIAGE.  143 

or  bowels  may  produce  the  same  effect.  In  other  cases,  an  indis- 
cretion of  diet,  followed  by  imperfect  digestion,  introduces  into  the 
blood  an  imperfectly-formed   material,  which  must  be  removed. 

Pathology. — Taking  the  humoral  view  of  this  disease,  we 
regard  it  as  being  produced  by  a  morbid  material  in  the  circula- 
tion. In  the  first  case,  from  retained  excretions ;  in  the  second, 
from  mal-digestion.  This  view  is  borne  out  by  the  history  of 
the  disease — always  terminating  by  the  re-establishment  of  secre- 
tion, and  by  the  treatment,  which  is  always  successful  when  it 
attains  this  end.  We  do  not  wish  to  ignore  the  existence  of  the 
nervous  system  in  this  view,  for  it  is  influenced  by  the  cause  of 
fever,  and  in  some  cases  its  morbid  action  is  capable  of  generat- 
ing such  a  blood-poison,  but  usually  this  is  but  a  minor  element. 

Symptoms. — The  symptoms  of  febricula  are  those  common  to 
all  fevers.  The  patient  has  a  chill  of  longer  or  shorter  duration, 
but  not  usually  of  much  severity.  Preceding  this  chill,  it  will 
be  observed,  sometimes  for  a  few  hours,  that  the  child  is  dull 
and  languid,  cross,  or  that  it  wants  to  sleep  more  than  usual. 
Following  the  chill,  the  pulse  increases  in  frequency,  and  the 
temperature  becomes  higher,  the  secretions  are  checked,  and 
there  is  more  or  less  excitement  of  the  nervous  system.  The 
febrile  reaction  comes  up  rapidly,  and  usually  attains  its  greatest 
intensity  in  from  two  to  four  hours.  It  may  continue  to  the 
termination  of  the  disease  as  a  continued  fever,  or  it  may  be 
broken  up  into  exacerbations  and  remissions. 

The  natural  duration  of  the  disease  is  from  one  to  three  days, 
the  fever  gradually  declining  for  the  last  third  of  the  time,  and 
finally  terminating  by  the  establishment  of  free  secretion. 

Occasionally,  during  its  progress,  the  excitation  of  the  nervous 
system  becomes  very  great,  and  the  child  suffers  severely  from 
this,  and  in  some  cases,  may  have  convulsions.  In  other  cases 
there  is  determination  of  blood  to  the  brain. 

Diagnosis. — There  is  no  difficulty  in  determining  that  the 
child  has  fever,  for  all  the  symptoms  are  very  clearly  defined. 
But  it  is  not  so  easy,  always,  to  determine  the  character  of  the 
disease.  The  points  that  I  rely  upon  to  effect  this  diagnosis  are 
these :  though  the  skin  is  hot,  it  is  never  dry  or  harsh ;  the 
tongue  is  uniformly  moist,  and  the  mucous  membranes  of  natural 
color;  though  the  pulse  is   frequent,  it  is  not  otherwise  much 


144  DISEASES  OF  CHILDEEN. 

changed,  but  gives  a  sensation  to  the  finger  of  normal  fullness, 
and  freedom  of  circulation.  As  the  reverse  of  this  is  shown  in 
the  more  persistent  fevers,  the  diagnosis  is  quite  plain. 

Peognosis.— The  prognosis  is  favorable  whether  the  patient 
has  treatment  or  not,  and  we  can  safely  say  that  the  disease  will 
terminate  favorably  by  the  close  of  the  third  day. 

Treatment. — If  secretion  is  arrested,  we  want  to  look  to  that, 
and  usually  but  little  additional  treatment  will  be  necessary. 
For  the  excited  circulation  and  to  favor  diaphoresis,  add  Aconite 
gtt.  v.  Asclepias,  gtt.  x.  to  xv.,  to  half  a  glass  water,  and  give  in 
teaspoonful  doses  every  hour  until  a  good  action  has  been  ob- 
tained. If  there  is  irritation  of  nervous  system,  alternate  Gelse- 
minum  with  the  sedative,  gtt.  x.  to  xv.  to  water  Siv.,  a  teaspoonful 
every  two  hours. 

If  the  child  is  vigorous,  a  warm  bath  may  be  given  once  a  day, 
but  if  delicate  the  dry  rubbing  or  the  employment  of  some  oily 
preparation  is  far  better. 

INTEKMITTENT  FEVERS. 

It  is  only  in  those  sections  of  county  where  the  malarial  poi- 
son is  intense,  that  young  children  have  ague ;  and  during  the 
first  six  months,  they  rarely  have  it,  even  in  these  localities. 
After  the  child  has  passed  the  age  of  two  years,  the  system  seems 
more  easily  impressed,  though  not  so  easily  as  after  the  age  of 
puberty. 

Cause. — The  cause  of  intermittent  fever  is  generally  conceded 
to  be  a  poison  generated  by  the  decomposition  of  vegetable  mat- 
ter, and  receives  the  name  of  "  vegetable  malaria." 

Pathology. — There  is  no  doubt  but  that  the  cause  of  inter- 
mittent fever  acts  upon  the  blood,  and  from  it  upon  other  parts 
and  functions.  There  is  always  a  period  of  incubation  in  which 
the  morbid  material,  whatever  it  may  be,  is  increasing.  Finally 
it  produces  depression  of  the  vital  powers,  and  'a  chill.  Then  the 
vitality  of  the  system  seems  concentrated  for  its  removal,  and  we 
have  the  febrile  reaction,  succeeded  by  the  sweating  stage,  in 
which  secretion  is  re-established. 

The  system  thus  freed  from  the  poison  enjoys  a  period  of  com- 
parative health  (the  intermission),  but  the  germs  of  the  poison 


TEMPEEATUEE,  ETC.  145 

still  remaining  in  the  body,  it  is  gradually  reproduced,  and  there 
is  another  period  of  depression,  reaction,  and  secretion.  Thus 
it  may  continue  for  an  indefinite  time,  the  system  never  freeing 
itself  entirely  from  the  cause  of  the  disease. 

Symptoms. — An  intermittant  fever  in  the  child,  presents  the 
same  symptoms,  and  in  the  same  order  as  in  the  adult.  There  is 
a  period  of  depression  for  a  short  time,  in  which  the  child  is 
dull,  its  face  pallid,  the  extremities  cold,  and  the  lips  and  finger 
nails  bluish.  The  chill  is  thus  introduced,  and  increases  in  inten- 
sity for  a  longer  or  shorter  time.  The  child  is  seen  to  be  cold, 
has  more  or  less  rigors,  its  pulse  is  small  and  increased  in  fre- 
quency, and  the  secretions  locked  up. 

Continuing  thus  for  a  short  time  (from  fifteen  minutes  to  two 
or  three  hours),  the  symptoms  of  the  chill  gradually  pass  away, 
the  surface  becomes  warm,  loses  its  bluish  appearance,  the  pulse 
increases  in  frequency,  and  the  symptoms  of  nervous  depression 
pass  away.  But  going  beyond  the  point  of  healthy  reaction,  the 
surface  becomes  hot  and  more  or  less  dry,  the  pulse  increased  in 
frequency  from  twenty  to  forty  beats  per  minute  beyond  the 
healthy  standard,  and  is  also  changed  as  to  freedom,  and  is  more 
or  less  hard,  and  the  nervous  system  is  excited,  with  a  gradual 
increase  in  the  febrile  symptoms.  The  fever  attains  its  maxi- 
mum intensity  in  from  two  to  six  hours,  and  there  is  then  a  like 
gradual  decline  to  the  sweating  stage. 

This  stage  of  an  intermittent  is  announced  by  the  diminished 
frequency  of  the  pulse,  and  disappearance  of  nervous  excitement. 
The  temperature  of  the  body  is  reduced,  and  the  child  breaks 
out  into  a  free  perspiration,  and  there  is  also  increased  secretion 
from  the  kidneys. 

There  is  then  a  complete  intermission,  the  child  presenting  no 
evidences  of  disease  for  twenty-four,  forty-eight,  or  seventy-two 
hours,  as  the  fever  is  quotidian^  tertian,  or  quartan  in  type,  except 
in  some  rare  cases  in  which  it  assumes  the  form  of  a  double  quo- 
tidian, there  being  two  revolutions  of  the  fever  each  day. 

This  period  being  passed,  there  is  again  a  recurrence  of  the 
phenomena  of  chill,  febrile  reaction,  sweating  stage,  and  inter- 
mission, until  finally  the  fever  wears  itself  or  the  patient  out,  or 
is  arrested  by  medicine. 

"With  Nervous  Complication. — In  some  eases  the  nervous 
system  suffers  severely.     There  is  very  great  depression  during 
10 


146  DISEASES  OF  CHILDREN. 

the  chill,  with  tendency  to  congestion.  And  during  the  febrile 
reaction  there  is  dullness,  with  tendency  to  coma.  In  other  cases 
there  is  very  great  excitation  of  the  nervous  system,  with  deter- 
mination to  the  nerve-centers.  And  this  will  sometimes  con- 
tinue during  the  intermission.  In  some  cases  the  ague  is  attended 
with  convulsions. 

With  Inflammatory  Complication. —  In  other  cases  we 
notice  a  very  high  febrile  reaction,  the  fever  being  prolonged 
beyond  the  usual  time.  The  sweating  stage  is  imperfect,  and 
during  the  intermission  the  child  still  suffers,  the  skin  is  dry,  the 
urine  scanty,  and  the  pulse  somewhat  hard. 

"With  Gastric  Complication. —  In  still  other  cases,  the 
stomach  and  associate  organs  seem  to  suffer  severely.  In  some 
the  stomach  is  very  irritable,  and  there  is  nausea  and  vomiting 
during  the  chill  and  early  part  of  the  febrile  reaction.  And  even 
in  the  remission,  the  irritability  of  the  stomach  remains,  so  that 
digestion  is  imperfectly  performed,  and  medicine  is  not  received 
kindly,  and  is  absorbed  slowly  and  with  difficulty. 

In  another  class  of  cases  the  tongue  is  pale,  broad,  and  coated 
with  a  white,  or  yellowish-white,  tenacious  fur.  The  appetite  is 
capricious,  digestion  imperfect,  and  nutrition  of  tissue  is  not 
well  performed.  Medicine  is  received  with  difficulty,  and  if  ab- 
sorbed at  all,  slowly,  and  does  not  act  kindly,  or  produce  its  usual 
influence. 

In  still  another  class  of  cases  the  mucous  membranes  are 
darker,  even  dusky,  and  the  coatings  of  the  tongue  are  also 
dark-colored.  Digestion  is  imperfect,  and  of  course  nutrition 
is  to  a  considerable  extent  suspended.  In  the  severer  cases  there 
is  a  tendency  to  septic  decomposition.  And  in  all,  the  usual 
antiperiodic  treatment  fails  to  arrest  the  disease. 

Treatment. — During  the  chill  the  child  must  be  kept  warm  ; 
this  may  be  aided  by  giving  warm  drink  occasionally,  and  there 
is  nothing  better,  especially  if  the  child  craves  drink,  than  hot 
lemonade,  sweetened  just  enough  to  make  a  pleasant  drink,  and 
let  it  be  taken  at  pleasure.  It  will  prove  a  grateful  and  efficient 
remedy.  As  soon  as  reaction  takes  place,  give  the  required  seda- 
tive with  any  other  remedy  that  may  be  indicated.  Aconite,  if 
the  pulse  is  small  and  rapid  and  there  are  no  complications. 
Veratrum,  if  the  jjulse   is  full  and  bounding  and  with  gastric 


INTERMITTENT  FEVEE.  147 

complication.  Asclepias  is  the  child's  diaphoretic  and  an  essential 
part  of  the  treatment,  when  the  skin  is  harsh  and  dry ;  Gelse- 
minum  is  always  to  be  thought  of  when  the  pupils  are  contracted 
and  face  flushed,  with  irritation  of  nervous  system.  If  there  is 
dullness  with  a  tendency  to  sleep,  indicating  congestion.  Bella- 
donna in  small  doses,  gtt.  iv.  to  viii.  to  water  Siv.,  a  teaspoonful 
every  half  hour  or  hour,  according  to  the  severity  of  the  case, 
will  prove  a  fine  remedial  agent.  As  soon  as  the  pulse  and  tem- 
perature begin  to  decline  and  secretion  is  established,  the  anti- 
periodic  is  to  be  given.  In  uncomplicated  cases  carbazotate  of 
ammonia  is  preferable  to  quinia ;  it  may  be  given  even  during  the 
fever  with  perfect  safety.  The  dose  is  small,  from  one-eighth  to 
one-sixth  of  a  grain,  triturated  with  sugar  of  milk  and  given 
every  three  hours.  When  complications  exist,  and  particularly 
if  there  is  considerable  depression,  quinia  is  preferable  to  any 
other  antiperiodic.  It  may  be  given  in  from  one  to  two  grain 
doses,  repeated  every  two  hours  during  the  intermission.  After 
the  chill  is  broken,  and  especially  in  malarial  localities,  it  is  best 
to  continue  the  antiperiodic  for  three  or  four  days,  giving  it  less 
frequently,  however,  in  one  grain  doses  twice  daily,  repeating  it 
on  the  seventh  day. 

Quinia  is  the  antiperiodic,  though  there  are  other  remedies  that 
act  in  the  same  manner,  but  less  efficiently.  I  prefer  to  give  a 
sufficient  quantity  in  a  single  dose,  rather  than  in  broken  doses. 
This  for  a  child  two  years  old,  will  be  from  two  to  three  grains. 
It  is  given  best  in  a  cold  infusion  of  green  tea.  If  the  chill  is 
broken,  it  may  be  repeated  for  two  or  three  days  in  one-grain  doses. 

For  some  days  afterwards,  it  will  be  well  to  continue  the 
Veratrum  or  Aconite,  and  in  a  malarial  country  repeat  the 
antiperiodic  every  seventh  day. 

In  the  nervous  complication,  with  dullness,  and  congestion  of 
the  nerve-centers,  I  use  Belladonna,  associated  with  Aconite,  as 
in  this  formula :  !l^  Aconite,  Belladonna,  aa.  gtt.  v.  water  5iv. ; 
a  teaspoonful  every  hour  during  fever,  and  every  three  hours 
during  the  intermission. 

Rhus  tox.  will  be  found  indispensable  in  some  nervous  compli- 
cations ;  give  it  in  alternation  or  with  the  Aconite. 

Stimulant  frictions  to  the  skin,  as  with  a  combination  of  some 
of  the  essential  oils  with  lard,  is  an  aid  to  the  treatment.  This 
means  is  continued  until  the  symptoms  are  no  longer  marked 
during  the  intermission,  and  then  quinine  is  given  as  before. 


148  DISEASES  OF    CHILJ)REN. 

In  the  second  form — with  irritation  of  the  nervous  system  and 
determination  of  blood — I  prescribe:  I^  Tincture  of  Gelseminum 
gtt.  X.  to  XX. ;  Aconite  or  Veratrum  gtt.  v. ;  water  Siv.  A  tea- 
spoonful  is  given  every  hour  while  there  is  fever,  and  every  two 
hours  during  the  remission.  If  the  symptoms  have  been  very 
severe,  the  acetate  of  potash  may  be  given  for  a  day  or  two  be- 
fore the  administration  of  the  antiperiodic. 

In  the  case  of  inflammatory  intermittent,  the  administration  of 
the  special  sedatives,  until  a  complete  sweating  stage  and  inter- 
mission is  produced,  will  frequently  be  all  that  is  required.  In 
the  more  persistent  cases,  gently  opening  the  bowels,  and  the  use 
of  a  solution  of  acetate  of  potash,  will  be  necessary.  The  im- 
portant point  in  all  of  these  cases  is,  not  to  give  the  quinine 
until  the  system  is  thoroughly  prepared  for  its  reception. 

The  gastric  complication  gives  the  greatest  trouble,  as  there  is 
not  only  imperfect  digestion  and  nutrition,  but  medicines  are  not 
absorbed  from  the  stomach.  In  the  first  case  named,  I  should 
give  the  patient  Nux  in  small  doses  every  hour,  and  the  usual 
doses  of  Aconite  with  Gelseminum.  The  child  may  have  a  hot 
foot-bath  once  or  twice  a  day,  or  sometimes  a  general  hot  bath. 
Cold  applications  over  the  stomach  will  usually  answer  a  better 
purpose  than  counter-irritants. 

In  severe  persistent  cases  the  following  local  application  will 
relieve  when  all  other  means  fail :  Take  of  cinnamon,  cloves  and 
alspice  aa.,  sufficient  quantity,  cover  with  good  whisky  and  water, 
equal  parts,  and  make  an  infusion,  strain  and  keep  it  hot,  wring 
flannel  cloths  out  of  this  and  apply  to  the  epigastric  region ;  it 
will  quickly  relieve  and  refresh  the  little  sufferers. 

When  the  tongue  is  broad,  and  coated  with  the  pasty  coat,  I 
advise  the  administration  of  sulphite  of  soda  in  doses  of  two  to 
four  grains,  every  two  or  three  hours.  When  this  condition  is 
very  marked,  and  the  disease  has  continued  for  some  time,  a 
thorough  emetic  is  the  shortest  road  to  a  cure.  In  the  meanwhile, 
the  child  should  have  Veratrum  in  smal|  doses  regularly,  and  if 
there  is^ervous  irritability,  Gelseminum. 

When  there  is  tlie  dusky  discoloration  of  the  mucous  mem- 
branes, the  patient  wants  Baptisia  and  Aconite  every  hour,  and 
the  quinine  should  be  given  in  the  form  of  an  elixir,  prepared 
w'ith  muriatic  or  nitric  acid  and  simple  syrup.  This  will  supply 
the  required  acid ;  and  render  the  antiperiodic  ready  for  immediate 
absorption. 


REMITTENT   FEVER.  149 

Where  quinia  can  not  be  given  by  mouth,  I  frequently  arrest 
the  disease  by  its  endermic  use.  Especially  in  the  nervous  and 
gastric  forms  of  the  disease,  this  method  will  be  found  beneficial. 
I  order  :  ^  Quinia  Sul.  5j-,  Adeps,  or  warm  olive  oil,  §ij.  Let 
the  child  be  thoroughly  rubbed  with  this  twice  daily  ;  brisk 
friction  while  it  is  being  employed  is  of  great  importance.  I 
have  not  failed  of  success  in  any  case,  with  this  method,  where 
the  internal  treatment  had  been  pursued  as  I  have  recommended. 

MASKED  INTERMITTENT. 

In  the  diseases  of  children,  as  with  the  adult,  we  meet  with 
many  cases,  in  which,  if  the  periodic  influence  is  not  the  cause 
of  the  disease,  it  continues  it,  and  prevents  success  from  the 
ordinary  treatment.  Many  of  these  cases  are  very  obscure,  ^tnd 
it  will  require  that  the  practitioner  be  impressed  with  the  im- 
portance of  closely  looking  for  the  malarial  complication,  that  it 
be  detected. 

Almost  all  of  the  inflammatory  diseases  may  be  thus  compli- 
cated, and  we  frequently  find  it  at  the  bottom  of  persistent  gas- 
tric and  intestinal  disturbance,  and  of  lesions  of  innervation, 
and  especially  of  nutrition.  In  the  adult  we  find  the  majority 
of  masked  intermittents  in  the  form  of  neuralgias. 

The  treatment  of  these  cases  will  be  the  same  as  for  an  ordi- 
nary intermittent,  and  quinia,  one  to  two  grains  in  the  form  of  an 
elixir,  may  be  given  with  an  acid ;  or  carbazotate  of  ammonia  or 
Alstonia  may  be  given,  in  the  following  doses :  grains  two  of  the 
first  every  two  hours  ;  from  one-sixth  to  one-fourth  grain  of  the 
second  every  three  hours,  and  one  to  three  grains  of  the  last 
four  times  a  day. 

REMITTENT  FEVER. 

The  fevers  of  childhood  are  almost  always  remittent  in  form. 
A  continued  fever,  being  of  very  rare  occurrence.  Thus  we  will 
have  remittent  fever  from  the  ordinary  malarial  cause  of  this 
disease  in  the 'adult,  and  also  from  the  various  causes  which  may 
give  rise  to  fever. 

The  disease  is  divided  into  two  varieties,  regular  infantile 
remiftent,  and  slow  infantile  remittent  fever.  The  first  possesses 
all   the   elements  of  a  fever,  and  runs  a  regular   and   uniform 


150  DISEASES  OF  CHILDREN. 

course ;  while  the  second  is  defective  in  many  of  its  symptoms, 
and  is  irregular  in  its  course  and  duration.  We  will  consider 
the  regular  form  of  the  disease  first. 

Causes. — As  just  remarked,  the  causes  of  infantile  remittent 
fever  are  of  two  kinds.  In  a  certain  proportion  of  cases,  it  is 
as  distinctly  malarial,  as  in  the  same  form  of  the  disease  in  the 
adult.  I  know  of  no  means  of  determining  this  cause,  other 
than  that  it  prevails  in  localities  and  at  times  when  the  adult 
remittent  fever  is  noticed.  The  ordinary  cause  of  continued 
and  typhoid  fever  in  the  adult — animal  malaria — will  produce  a 
species  of  remittent  fever  in  the  child.  The  ordinary  causes  of 
simple  fever,  cold,  arrest  of  secretion,  imperfect  digestion,  defi- 
cient waste  of  tissue,  whatever  may  be  their  origin,  will  give 
rise  to  this  disease. 

Pathology. — The  febrile  poison,  whatever  may  have  been 
its  source,  seems  to  act  primarily  upon  the  blood.  During  the 
incubation  of  the  disease,  which  occupies  a  longer  or  a  shorter 
period  of  time,  the  solids  of  the  body  become  to  some  extent 
involved  through  impaired  nutrition.  Thus,  when  the  febrile 
symptoms  are  fully  announced,  there  is  the  double  lesion,  a 
morbid  material  in  the  circulation  and  impaired  vitality  of  the 
blood,  and  imperfect  material  through  all  the  tissues  of  the  body, 
from  the  depraved  nutrition. 

For  the  first  days  of  the  fever,  the  lesions  seem  principally  of 
function,  but  as  the  disease  is  protracted,  the  solids  of  the  body 
become  more  and  more  affected.  This  is  in  three  ways — by  the 
impairment  of  the  vitality  of  tissue,  by  the  febrile-reaction — by 
imperfect  waste,  leaving  worn-out  and  dead  tissue  in  its  place — 
and  by  imperfect  and  faulty  nutrition,  whereby  feeble  and  im- 
perfect tissues  are  formed. 

Post-mortem  examination  shows  a  deterioration  of  the  blood, 
and  in  some  of  the  worst  cases,  the  red-corpuscles  of  the  blood 
are  much  broken  down.  There  is  usually  some  evidences  of 
congestion-  and  infiltration,  especially  of  organs  which  have 
suffered  from  irritation  dui^ng  the  progress  of  the  disease.  The 
tissues  are  but  little  softened  in  the  majority  of  cases.  The  local 
lesions  are  principally  inflammatory  in  their  character,  and  owing 
to  complications. 

Symptoms. — In  the  majority  of  cases  there  is  a  forming  stage 
of  from  one  to  six  days.     During  this,  the  child  seems  dull  and 


REMITTENT   FEVER.  161 

listless  at  times,  at  other  times  is  cross  apd  fretful.  Sleeps  at 
unusual  times  during  the  day,  but  .not  soundly,  and  is  restless 
and  uneasy  at  night.  The  appetite  fails,  the  bowels  are  irregu- 
lar, and  occasionally  slight  febrile  exacerbations  occur. 

The  chill  is  not  usually  so  marked  as  to  attract  notice.  The 
child  seems  very  quiet  and  dull,  draws  up  to  the  fire,  and  wants 
to  drink  more  than  usual.  Lasting  but  a  short  time,  febrile 
reaction  comes  up  quickly,  and  in  a  couple  of  hours  presents  its 
most  marked  symptoms.  The  skin  is  hot  and  somewhat  dry, 
the  pulse  frequent  and  hard,  the  mouth  dry,  and  the  tongue  coated 
white ;  the  urine  is  scanty,  the  bowels  constipated,  and  there  is 
considerable  nervous  irritation. 

The  fever  varies  considerably,  as  regards  the  remissions.  In 
some  cases  there  is  but  one  remission,  and  that  usually  in  the 
morning ;  in  others  there  are  two,  and  in  others  three,  and  in 
still  others  the  fever  is  broken  up  into  short  febrile  exacerbations 
of  irregular  duration,  so  that  there  may  be  a  dozen  or  more  in 
the  course  of  twenty- four  hours. 

As  the  disease  progresses,  the  symptoms  increase  in  severity, 
the  febrile  reaction  is  higher  and  more  prolonged,  and  the  re- 
missions less  marked.  The  important  functions  are  also  involved 
to  a  greater  extent,  and  the  patient  more  and  more  debilitated. 

Remittent  fever  is  frequently  complicated,  and,  as  a  general 
rule,  the  greatest  danger  to  life  is  from  this.  The  more  common 
complications  are,  of  the  brain,  the  digestive  organs,  and  of  the 
respiratory  apparatus. 

With  Disease  of  the  Brain. — There  are  two  principal 
lesions  of  the  brain,  noticed  early  in  the  disease.  These  are — 
irritation  with  determination  of  blood,  and  congestion. 

In  the  first  case,  the  child  is  noticed  to  be  more  than  usually 
restless  and  fretful,  its  eyes  are  bright,  and  it  is  continually 
wanting  drink,  and  various  things  that  it  sees.  In  a  short  time 
it  is  noticed  that  the  face  and  scalp  are  flushed,  the  head  is  hotter 
than  usual,  the  eyes  are  bright,  with  contracted  pupils,  and  the 
restlessness  has  increased.  The  disturbance  thus  commenced 
may  go  on  to  the  development  of  inflammation,  or  after  lasting 
for  some  time — three  or  four  days — may  terminate  in  congestion 
and  coma ;  or  in  other  cases,  the  excitement  may  eventuate  in 
the  production  of  convulsions. 

In  the  second  case,  the  child  is  dull,  and  has  a  tendeney  to 
sleep  much,  but  sleeps  with  its  eyes  partly  opened.     The  eyes  are 


152  '  DISEASES   OF  CHILDREN. 

dull,  pupils  frequently  dilated,  and  the  face  has  a  heavy,  expres- 
sionless appearance.  As  the  case  progresses,  coma  comes  on,  and 
gradually  deepens  until  it  becomes  impossible  to  arouse  the  child 
from  it. 

With  Deeangement  of  the  Digestive  Organs. — The 
common  lesions  of  this  apparatus  are — irritation  of  the  stomach, 
and  atony  of  the  stomach  with  morbid  accumulations.  The 
irritable  stomach  is  readily  recognized  in  most  cases.  The  child 
can  not  take  food,  drink,  or  medicine,  without  nausea  and  retch- 
ing. The  tongue  is  elongated  and  pointed,  tip  and  edges  more 
or  less  reddened,  and  the  coating — usually  white — confined  to  its 
center. 

In  the  second  case  there  is  also  nausea  and  efforts  at  vomiting, 
food  is  not  digested,  and  medicine  produces  sickness  and  is  not 
absorbed.  The  tongue  is  unusually  pale,  broad,  and  covered 
with  a  pasty  white  coat. 

In  both  of  these  cases,  the  disease  runs  its  course  more  rapidly. 
Not  only  on  account  of  the  sympathetic  derangements  that  flow 
from  such  gastric'  disturbance,  but  also  because  digestion  is 
arrested,  and  all  our  means  of  cure  are  inefficient  because  not 
absorbed. 

With  Disease  of  the  Respiratory  Apparatus. — In  the 
winter  and  spring,  infantile  remittent  fever  is  frequently  compli- 
cated with  disease  of  the  respiratory  organs.  In  the  majority  of 
cases,  it  is  nothing  more  than  an  irritation,  with  a  more  or  less 
troublesome  cough.  In  others,  a  well  developed  bronchitis,  and 
in  others,  a  lobular  pneumonia  is  set  up. 

The  symptoms  are  usually  very  plain.  The  child  has  cough, 
with  increased  frequency  of  respiration,  and  sometimes  slight 
difficulty  in  breathing.  At  first  there  is  dryness  of  the  bronchial 
mucous  membrane,  afterward  increased  secretion.  Where  these 
symptoms  are  marked,  a  physical  examination  of  the  chest  should 
be  made,  to  determine  the  character  of  the  trouble. 

Diagnosis.— The  diagnosis  of  an  infantile  remitttent  fever  is 
easily  made.  From  fehricula,  we  determine  it  by  the  dry  skin, 
hard  pulse,  and  dry  or  broad  and  pale  tongue.  From  continued 
fever,  by  the  regular  appearance  of  remissions.  From  inflam- 
matory diseases,  by  the  absence  of  local  symptoms ;  for  even 
when  complicated,  the  local  symptoms  are  distinctly  secondary. 


REMITTENT   FEVER.  153 

Prognosis. — The  prognosis  is  favorable.  Unless  the  compli- 
cations are  severe,  there  is  little  danger  of  a  fatal  termination  in 
viable  children.  As  heretofore  noticed,  a  certain  proportion  of 
children  are  won-viable,  and  will  die  of  any  disease,  or  even 
without  any  disease,  before  they  have  passed  the  age  of  child- 
hood. The  mortality  to  be  expected  in  the  course  of  ordinary 
practice  will  be  from  two  to  five  per  cent.,  depending  upon  the 
fact  just  stated. 

Treatment. — The  treatment  of  a  remittent  fever  is  usually 
very  simple,  and  also  very  successful.  The  first  object  is  to 
reduce  the  pulse  to  the  normal  standard,  and  get  a  free  and  equal 
circulation  of  blood.  The  second,  to  remove  any  irritation  or 
other  derangement  of  the  nervous  system.  The  third,  to  estab- 
ish  secretion,  and  get  a  good  condition  of  the  digestive  apparatus. 
The  fourth,  the  employment  of  agents  to  antagonize  the  malarial 
or  other  cause  of  disease. 

The  first  indication  is  very  surely  accomplished  by  the  use  of 
the  special  sedatives,  and  the  accessory  means — a  general  bath 
once  or  twice  daily,  and  the  hot  foot-bath.  I  usually  prescribe  : 
I^  Tincture  of  Aconite  or  Tincture  of  Veratrum  Viride  gtt.  v. 
to  gtt.  X.,  water  Siv. ;  a  teaspoonful  every  hour.  The  action  of 
these  remedies  should  not  be  looked  for  at  once ;  they  require 
time,  but  it  is  noticed  that  under  their  use  there  is  a  continuous 
amendment  in  all  the  symptoms.  In  the  course  of  forty-eight 
hours,  the  febrile  reaction  has  to  a  considerable  extent  subsided, 
the  pulse  is  but  little  above  the  normal  standard,  and  the  circu- 
lation is  free  and  uniform ;  and  we  are  ready  to  look  after  the 
second  indication. 

As  a  general  thing,  we  will  not  need  to  use  any  special  reme- 
dies to  relieve  the  nervous  system,  for  any  irritation  or  other 
disturbance  will  pass  away  with  the  febrile  reaction.  The  special 
cases  that  demand  treatment  will  be  named  hereafter. 

The  third  indication  is  also  frequently  fulfilled  by  the  action 
of  the  special  sedatives,  without  other  means.  But  when  secre- 
tion is  not  established  as  we  should  like,  we  put  the  little  patient 
on  tincture  of  Asclepias  5i.  to  water  .^iv.,  a  teaspoonful  every  hour, 
which,  with  a  hot  mustard  foot-bath,  will  soon  establish  secretion 
from  the  skin.  More  frequently  we  will  want  to  stimulate  the 
action  of  the  kidneys,  as  being  the  most  important  excretory 
organ.     For  this  purpose  I  prefer  a  solution  of  acetate  of  potash. 


154  DISEASES   OF  CHILDEEN. 

Secretion  from  the  bowels  should  be  obtained  by  minute  doses 
of  Podophyllin,  as  named  in  the  first  part  of  this  work,  or  other 
laxative.  Or,  if  there  is  simply  retention  of  feces,  it  may  be 
overcome  by  the  use  of  mild  laxatives  or  enemata.  Purgatives 
should  not  be  used  unless  there  is  a  special  indication  for  their 
employment. 

The  fourth  indication  of  cure  is  accomplished  in  the  strictly 
malarial  cases,  by  the  administration  of  quinine  in  doses  of  one 
to  two  grains  every  two  hours,  given  with  an  acid.  I  never  give 
quinine  to  child  or  adult  until  I  have  so  prepared  the  system  for 
its  reception  that  it  will  act  kindly,  and  as  a  curative  agent. 
With  the  action  of  the  sedatives,  and  secretion  beginning  to  be 
established,  it  may  be  given  with  a  considerable  degree  of  cer- 
tainty. 

With  the  subsidence  of  the  disease,  and  the  establishment  of 
convalescence,  but  little  medicine  will  be  required.  T  think  it 
advisable  to  give  the  sedatives  in  quite  small  doses,  for  two  or 
three  days  after  the  fever  has  entirely  passed  away,  as  the  child 
convalesces  more  rapidly  under  their  influence.  In  some  cases, 
a  restorative  aids  recovery.  Elixir  of  Guarana,  gtt.  x.  four 
times  daily,  or  Comp.  Spirits  of  Lavender,  answers  a  very  good 
purpose.  Or  in  some  cases,  dilute  muriatic  acid  Sij-  to  simple 
syrup  5>j.,  half  a  teaspoonful  in  water  as  a  drink,  every  three  or 
four  hours,  will  answer  a  good  purpose. 

Determination  of  blood  to  the  brain  is  arrested  by  the  adminis- 
tration of  Gelseminum,  which,  in  this  respect,  is  specific  in  its 
action.  I  usually  give  it  in  combination  with  the  sedatives,  pre- 
ferring, when  the  fever  runs  high,  to  dispense  with  the  Aconite, 
and  increase  the  quantity  of  the  Veratrum.  In  the  majority  of 
cases,  ten  drops  to  the  four-ounce  mixture,  is  sufficient.  But 
when  the  determination  is  active,  and  likely  to  progress  to  in- 
flammation, I  prescribe  twenty  drops  to  four  ounces  of  water. 
When  there  is  danger  of  convulsions  from  the  same  cause,  Gel- 
seminum may  be  relied  on  with  great  certainty  to  prevent  it. 

The  dull,  congested  condition,  with  tendency  to  coma,  is  an- 
tagonized by  the  administration  of  Belladonna,  which  is  also 
specific  in  its  action.  I  generally  prescribe  it  with  Aconite,  in 
the  following  proportion  :  I^  Tincture  of  Aconite,  Tincture  of 
Belladonna,  aa.  gtt.  v.,  water  5iv. ;  a  teaspoonful  every  hour. 
The  hot  stimulant  foot-bath,  and  occasionally  counter-irritation 
to  the  spine,  will  be  beneficial.     But  the  dry  rubbing,  in  both 


EEMITTENT   FEVER.  155 

raikl  and  severe  cases,  will  frequently  be  all  that  is  desired.  It 
arouses  the  inactive  condition  of  the  system,  restores  the  capillary 
circulation,  and  with  the  internal  use  of  Belladonna,  the  cure  is 
complete.  The  rubbing  or  dry  bathing  must  be  done  gently  but 
thoroughly,  five  minutes  being  sufficient  time  to  operate,  repeat- 
ing it  every  hour  and  a  half  or  two  hours,  the  hand  movements 
being  from  the  base  of  the  brain  down  to  the  sacrum,  the  arms, 
thorax  and  abdomen  operated  on  in  the  same  manner.  I  have 
removed  the  congestion  in  very  severe  cases  with  no  other 
remedies  than  these.  The  Belladonna  wants  to  be  given  in 
small  doses.  Children  being  very  susceptible  to  its  influence, 
from  gtt.  iv.  to  viii.  added  to  half  a  glass  of  water,  and  given  in 
teaspoonful  doses  every  half  hour  will  give  excellent  results. 

The  irritation  of  the  stomach  is  met  by  the  use  of  cold  or  warm 
applications  to  the  epigastrium,  and  heat  and  stimulants  to  the 
extremities  as  the  external  means.  Internally,  Nux  or  Ipecac 
may  be  given,  and  they  will  do  the  work  best  if  given  with  as 
little  fluid  as  possible.  To  accomplish  this  the  preparation  of 
Nux  should  be  made  stronger  than  usual,  about  gtt.  v.  to  the 
ounce  of  water,  and  give  gtt.  xv.  every  half  hour.  Ipecac  will 
operate  charmingly  in  severe  cases,  if  given  in  doses  varying 
from  one-tenth  to  one-sixth  of  a  grain  according  to  age  of  child. 
If  there  is  nausea  with  flatulence,  Colocynth  alternated  with  the 
Ipecac  will  be  the  remedy ;  or  subnitrate  of  bismuth,  in  mint 
water.  These  are  continued  until  the  irritation  is  removed.  At 
the  same  time,  small  doses  of  Aconite  may  be  given  for  its  seda- 
tive efiect,  and  also  for  its  influence  in  controlling  the  irritation 
of  the  solar  plexus  of  nerves,  which  attends  the  gastric  irritation. 

ISIueh  care  will  be  required  in  these  cases,  to  prevent  a  renewal 
of  the  gastric  irritation,  as  the  disease  progresses,  especially  to 
give  our  remedies  in  such  way  that  they  will  not  be  likely  to 
produce  it. 

In  the  second  case,  with  atony  and  morbid  accumulations,  if 
the  symptoms  are  marked,  the  shortest  method  will  be  to  give  a 
prompt  emetic.  This  is  not  a  pleasant  means  with  children  ;  but 
when  the  symptoms  are  grave,  it  is  the  most  successful  method. 

In  malarial  localities  the  emetic  is  usually  a  first  consideration, 
as  it  is  worse  than  useless  to  give  the  child  other  remedies  until 
the  stomach  has  been  placed  in  a  condition  to  receive  them. 
Tlie  acetous  emetic  tincture  or  an  infusion  of  gentian-root  is 
preferable  to  use.     In  the  same  cases  it  will  be  absolutely  essen- 


156  DISEASES  OF  CHILDREN. 

tial  to  use  :  ^  Podophylliu  gr.  1-20,  Leptandrin  gr.  1-15,  sugar 
of  milk  sufficient  to  make  one  grain  of  the  powder.  Dose,  one 
every  three  hours  during  the  first  day,  and  three,  one  at  morning, 
noon  and  night,  during  the  second  day. 

In  other  cases,  sulphite  of  soda  in  five  grain  doses,  may  be 
administered  every  two  or  three  hours,  or  if  the  tongue  is  red 
and  dirty,  sulphurous  acid. 

As  a  general  rule,  disease  of  the  respiratory  organs  will  yield 
readily  to  the  treatment  for  the  fever.  If  an  inflammation  is 
developed,  I  advise  the  mush-jacket  to  the  chest.  And  if  there 
is  much  cough,  some  simple  remedy  to  reliev^e  this.  IB^  Cam- 
phorated Tincture  of  Opium,  Syrup  of  Lobelia  aa:  Sss.,  Simple 
Syrup  Siii.  M.  Dose  from  x.  to  xx.  gtt.  three  or  four  times  a 
day.  Or,  ^i  Chlorate  of  Potassa  3ss.,  Tinct.  Aconite  gtt.  x., 
Tinct.  Opium  5ss.,  Simple  Syrup  Siv.  M.,  and  give  a  teaspoonful 
four  times  a  day. 

SLOW  INFANTILE  REMITTENT  FEVER. 

This  disease  is  not  only  slow  in  its  progress,  but  also  obscure 
in  its  symptoms,  so  that  many  times  it  is  very  difficult  to  make  a 
correct  diagnosis.  As  before  remarked,  more  or  less  of  the 
symptoms  of  fever  are  wanting,  and  others  are  quite  irregular. 

Causes. — In  a  part  of  the  cases  that  come  under  our  notice, 
the  cause  is  undoubtedly  the  malarial  poison  that  produces  other 
forms  of  periodic  disease.  This  may  be  taken  for  granted,  when 
it  occurs  in  a  malarial  region,  or  if  the  child  has  been  exposed  to 
this  cause,  however  temporarily. 

In  other  cases,  the  disease  is  produced  by  derangement  of  the 
digestive  organs,  by  imperfect  nutrition  and  waste,  by  deficient 
excretion,  and  indeed  by  any  of  the  many  causes  of  diseased 
action. 

Pathology. — As  with  the  other  fevers,  this  must  also  be  re- 
garded as  primarily  a  disease  of  the  blood,  but  as  it  advances,  all 
the  functions  arc  impaired,  and  there  is  also  a  continued  deterio- 
ration of  tissue.  An  arrest  of  nutrition  is  a  prominent  feature, 
so  that  waste  contiiuiing,  the  child  becomes  very  much  reduced 
in  flesh. 

There  are  no  special  evidences  of  diseased  action,  found  upon 
post-mortem  examination,  unless  there  has  been  some  local  com- 


REMITTENT  FEVER.  157 

plication,  which  generally  manifests  itself  during  life,  by  well 
pronounced  symptoms. 

Symptoms. — For  a  week  or  two  the  mother  notices  that  the 
child  is  not  so  well  as  usual.  Its  appetite  is  variable,  its  temper 
capricious,  is  fretful  and  irritable,  is  sometimes  dull,  wants  to 
sleep  at  unusual  times,  but  does  not  sleep  easily  or  well  at  regu- 
lar times,  is  restless  and  uneasy  at  night,  tossing  about  in  the 
bed,  and  wants  to  drink  frequently.  These  symptoms  slowly  in- 
crease, and  the  parents  finding  it  is  not  the  temporary  ailment 
from  cold  or  teething  that  they  supposed,  call  a  physician. 

He  hears  the  history  of  the  case  as  above,  and  an  examination 
confirms  the  symptoms.  He  also  finds  that  the  pulse  is  not 
natural,  but  has  a  sharper  beat,  is  a  little  more  frequent,  and  has 
an  unusual  hardness  in  some  cases,  is  softer  and  more  easily  com- 
pressed in  others. 

The  tongue  shows  evidence  of  disease  in  its  change  of  form 
and  its  coating.  In  a  few  cases  it  is  contracted,  and  presents  a 
dusky  redness,  and  the  coating,  if  any,  has  a  shade  of  brown. 
In  the  larger  number  of  cases  it  is  more  or  less  pallid,  frequently 
broader  and  seemingly  larger  than  common ;  in  both  cases  the 
coating  is  a  dirty  or  yellowish  white. 

The  bowels  are  irregular,  and  the  feces  unnatural.  In  some, 
the  feces  are  dark-colored,  brownish,  or  greenish,  in  state  of  effer- 
vescence, and  have  a  peculiar  fetor.  This  is  more  frequent  with 
the  dusky-red  tongue,  and  is  generally  said  to  indicate  acidity  of 
the  primce  vice ;  whether  this  is  so  or  not,  it  is  best  remedied  by 
the  administration  of  an  acid.  In  other  cases  the  feces  are  light- 
colored,  papescent,  and  have  not  the  natural  feculant  odor. 

The  skin  is  dry,  and  in  bad  cases  gives  a  parchment-like  sensa- 
tion to  the  hand.  Frequently,  the  extremities  are  cold,  and  in 
some  cases  the  temperature  of  the  child  is  lower  for  a  considera- 
ble portion  of  the  day. 

The  urine,  if  it  be  observed,  will  usually  be  found  free,  pale, 
and  of  low  specific  gravity,  although  the  waste  of  tissue  is  going 
on  rapidly.  In  some  cases  it  is  highly  colored,  stains  the  clothes, 
and  possesses  in  an  eminent  degree,  the  urinous  odor. 

At  some  period  of  the  day,  slight  febrile  symptoms  are  devel- 
oped, and  continue  for  one  or  two  hours.  But  they  are  not  very 
well  marked,  and  frequently  escape  notice.  As  soon,  however, 
as  the  attention  is  drawn  to  it,  the  periodicity  of  the  disease  will 
be  noticed. 


158  DISEASES  OF    CHILDEEN. 

Continuing  on  thus  for  weeks,  the  child  becomes  much  reduced 
in  flesh,  and  it  no  longer  has  the  strength  to  sit  up,  or  make  an 
effort  at  play.  Finally,  if  not  arrested,  or  it  is  not  naturally 
removed,  some  local  complication  is  set  up,  which  runs  an  acute 
course,  and  causes  a  fatal  termination. 

Diagnosis. — The  diagnosis  of  slow  infantile  remittent  fever 
is  made  by  exclusion.  The  evidences  of  disease  are  very  marked, 
but  what  the  disease  is,  is  obscure.  The  patient  is  examined 
with  reference  to  local  lesions.  Is  there  disease  of  the  brain  or 
nervous  system,  of  the  digestive  organs,  of  the  respiratory  sys- 
tem, or  of  the  excretory  organs  ?  We  determine  there  is  not. 
It  is  then  a  disease  of  the  blood,  and  a  lesion  of  nutrition  and 
waste,  and  the  symptoms  observed  will  readily  determine  its 
periodicity. 

Prognosis. — The  prognosis  is  favorable  if  the  disease  is  diag- 
nosed, and  a  proper  treatment  adopted.  But  in  its  advanced 
stages  it  will  not  bear  a  harsh  or  very  active  treatment,  but,  on 
the  contrary,  requires  time  and  patience.  The  vitality  of  the 
patient  is  so  exhausted,  and  the  functions  are  so  impaired,  that 
they  require  gentle  and  judicious  stimulation  to  obtain  the  de- 
sired action. 

Treatment. — I  place  the  patient  upon  the  use  of  Aconite 
alone,  if  the  pulse  is  soft  and  feeble,  giving  it  in  the  usual  doses. 
If  the  pulse  is  hard,  I  associate  Veratrum  with  it  in  the  propor- 
tions already  named.  I  regard  the  action  of  the  sedatives  as 
very  important  in  these  cases,  improving  the  circulation,  both  as 
to  frequency,  freedom,  and  an  equal  distribution  of  blood.  No 
disease  will  better  illustrate  the  fact  that  these  remedies  called 
sedatives,  are  really  stimulant  and  tonic  to  the  heart  and  blood- 
vessels. 

The  sedatives  are  continued  for  one,  two,  or  three  days  alone, 
or  with  but  little  other  medicine,  and  aided  by  the  general  bath 
and  hot  foot-bath.  A  salt-water  bath  answers  a  very  good  pur- 
pose to  stimulate  the  surface.  We  find  that  the  circulation  be- 
comes better,  the  skin  less  dry,  bowels  more  regular,  innervation 
better,  indeed,  that  every  function  has  improved  slightly  under 
their  use. 

If  there  has  been  marked  dullness  and  hebetude  of  the  ner- 
vous system,  the  combination  of  Belladonna  and  Aconite  should 


EEMITTE^'T   FEVEE.  159 

be  employed.  If  there  is  irritation  of  the  nervous  system,  Gel- 
seminum,  or  Rhus,  as  indicated,  should  be  substituted.  These 
means  of  meeting  special  indications,  should  not  be  neglected. 

With  the  influence  upon  the  system  named  above,  we  may 
give  remedies  to  call  the  excretory  organs  into  action,  if  it  seems 
necessary.  The  administration  of  small  doses  of  Podophyllin, 
triturated  as  heretofore  named,  with  one-fourth  or  one-half  a 
grain  of  Sulphate  of  Hydrastia,  three  or  four  times  a  day,  in- 
creases secretion  from  the  intestinal  canal,  and  improves  the  ap- 
petite. Acetate  of  potash,  to  the  extent  of  ten  grains  daily,  will 
give  free  excretion  by  way  of  the  kidneys. 

Whether  we  use  these  means  to  increase  secretion  or  not,  we 
find  a  very  important  aid  to  the  cure  in  quinine.  I  consider  the 
patient  prepared  for  its  administration  whenever  the  pulse  be- 
comes soft,  the  skin  soft  and  moist,  and  the  tongue  moist  and 
cleaning.  Usually,  I  give  from  two  to  three  grains  at  one  dose, 
and  afterward  repeat  it,  one  grain  each  day,  for  three  or  four 
days,  or  may  be  a  week. 

When  quinine  by  mouth  is  objected  to,  or  there  is  any  other 
reason  for  not  giving  it  in  this  way,  I  use  it  by  inunction.  I  am 
satisfied  that  in  some  cases  this  use  is  decidedly  preferable  to  the 
other,  being  more  certain,  as  well  as  pleasant.  I  have  the  child 
thoroughly  rubbed  once  or  twice  a  day  with  an  ointment  of  one 
drachm  of  quinine  to  two  ounces  of  lard. 

In  some  cases  we  find  the  tongue  broad,  pale,  and  covered 
with  a  pasty  coat.  If  these  symptoms  are  very  marked,  the 
mouth  being  nasty,  and  the  breath  fetid,  I  think  the  speediest 
method  is  the  administration  of  a  thorough  emetic,  and  its  repe-^ 
tition  if  necessary.  In  place  of  this  I  give  the  sulphite  of  soda 
in  the  usual  doses,  repeated  every  two  hours.  Rhus,  Belladonna, 
Gelseminum,  Apis,  Arsenicum,  and  other  remedies,  will  find  a 
place  in  this  disease  according  to  indications. 

When  the  mucous  membranes  present  the  dark-red  or  dusky 
appearance,  a  very  marked  effect  follows  the  use  of  muriatic  acid. 
Some  very  persistent  cases,  that  have  been  intractable  to  the 
ordinary  method,  will  yield  readily  to  the  same  treatment  with 
the  acid  addition. 

As  a  general  rule,  when  the  disease  is  soon  arrested  in  its 
course,  convalescence  is  steady,  and  tolerably  rapid.  Where  it 
is  not,  we  may  put  the  patient  upon  the  restoratives  named  in 
the  treatment  of  the  preceding  form  of  fever. 


160  DISEASES  OF  CHILDEEN. 

CONGESTIVE  FEVER. 

There  is  a  form  of  fever  in  childhood  that  may  be  properly 
called  congestive,  resembling  in  many  of  its  symptoms  the  con- 
gestive remittent  fever  of  the  adult.  It  might  have  been  passed 
by  with  the  brief  notice  given  in  remittent  fever,  complicated 
with  congestion  of  the  brain ;  but  it  would  leave  the  student  of 
medicine  at  a  loss,  when  he  was  called  to  cases  which,  though 
distinctly  febrile,  presented  the  predominant  symptoms  of  con- 
gestion. 

Pathology. — The  causes  of  tbis  may  be  the  same  as  produce 
any  form  of  fever ;  the  congestive  character  of  the  disease  de- 
pending upon  the  condition  of  the  patient,  rather  than  the  causes 
of  the  disease.  In  the  majority  of  cases,  however,  there  is  some- 
thing in  the  cause  which  seems  to  paralyze  the  vegetative  or  sym- 
pathetic nerves,  and  which  occasions  the  congestion.  In  some 
seasons,  and  in  some  localities,  we  find  a  tendency  to  this  form 
of  disease. 

Post-mortem  examination  evidences  the  local  engorgements  of 
blood,  in  discoloration,  and  transudation.  In  the  severer  cases, 
the  blood  is  more  broken  down,  and  the  tissues  more  softened, 
than  in  ordinary  fevers. 

Symptoms. — As  a  general  rule  the  chill  is  protracted  and 
better  marked  than  in  the  fevers  described.  Indeed,  in  some 
cases  it  will  last  the  greater  part  of  the  twenty-four  hours,  not 
presenting  so  much  a  coldness  as  a  dullness  and  hebetude. 

As  the  febrile  reaction  comes  up,  the  child  is  not  excited,  but 
sleeps  or  dozes  with  its  eyes  partly  open,  and  a  full  and  expres- 
sionless appearance  of  the  face.  This  continues  until  the  fever 
commences  to  decline,  when  the  child  arouses  up  and  seems  more 
lively  and  better.  This  condition  of  the  nervous  system  con- 
tinues throughout  the  disease,  gradually  increasing  as  the  fever 
becomes  more  intense,  becoming  a  profound  coma  in  the  severer, 
and  especially  in  the  fatal  cases. 

The  pulse  is  full  and  somewhat  labored,  or  in  some  cases  the 
casual  observer  would  notice  but  little  change  from  its  normal 
state,  beyond  its  frequency.  There  is  distinct  evidence  of  an 
impaired  capillary  circulation,  in  the  fullness  of  loosely  connected 
tissues  and  the  dusky  redness  or  lividity.  The  circulation  be- 
comes more  free  during  the  remission,  and  the  symptoms  of  con- 
gestion pass  away. 


CONGESTIVE   FEVER.  161 

I  have  noticed  the  lesion  of  the  nervous  system,  which  is  so 
constant  as  to  be  a  part  of  almost  every  fever.  But  there  are 
also  local  congestions,  which  become  very  marked. 

The  respiratory  apparatus  suffers  in  this  way  in  many  cases!  It 
is  noticed  that  the  child  has  a  slight  cough,  attended  with  some 
difficulty  in  breathing,  and  occasionally  removing  a  frothy  mucus. 
In  a  few  hours  the  breathing  becomes  labored,  there  is  a  marked 
rattling  or  blowing  sound  in  the  chest.  The  cough  fails  to  raise 
anything,  though  it  is  evident  there  is  increased  secretion,  and 
the  evidences  of  imperfect  aeration  of  the  blood  become  well 
marked.  Continuing  on  in  this  way,  we  find  all  the  symptoms 
increasing  rapidly,  and  sometimes  death  will  ensue  in  twenty- 
four  to  forty-eight  hours. 

In  other  cases  there  is  evident  congestion  of  the  abdominal 
viscera,  and  arrested  function  of  stomach,  liver,  intestinal  canal, 
etc.  The  symptoms  are  not  so  distinct  as  in  the  preceding  case  j 
yet  the  prostration  of  the  little  patient,  the  fullness  and  evident 
uneasiness  in  this  region,  are  pretty  good  evidence.  Add  to  this 
that  the  respiratory  function  is  oppressed,  and  the  breathing 
principally  thoracic,  with  an  absence  of  the  physical  signs  of 
disease  of  the  lungs,  and  the  diagnosis  becomes  quite  plain,     ^f\ 

Congestion  of  the  kidneys  is  announced  by  a  rapid  increase 
of  coma,  attended  by  a  scanty  or  arrested  secretion  of  urine. 

Diagnosis. — There  is  usually  but  little  difficulty  in  making 
the  diagnosis  of  this  disease.  The  evident  impairment  of  the 
circulation  is  manifested  by  the  pulse,  and  by  the  appearance  of 
the  patient.  The  dullness  and  hebetude,  and  the  development 
of  coma,  are  very  characteristic.  The  local  lesions  are  very 
readily  determined,  as  named  above. 

Prognosis.— If  not  properly  treated,  the  prognosis  is  not  so 
favorable  as  in  other  forms  of  fever.  It  frequently  runs  its 
course  to  a  fatal  termination  by  the  fourth  or  fifth  day.  But  if 
attention  is  given  to  this  feature  of  the  disease  at  the  commence- 
ment, with  our  special  remedies,  the  mortality  will  be  but  little 
greater  than  in  other  forms  of  fever. 

Treatment.— There  are  two  methods  of  overcoming  this  (Con- 
gestive condition,  both  of  them  good,  though  differing  entirely  in 
their  character  and  mode  of  action.     The  first  of  these  methods  is 
by  active  emesis,  the  second  by  the  specific  action  of  Belladonna. 
11 


162  DISEASES  OF  CHILDREN. 

There  are  some  cases  in  which  I  should  prefer  the  employment 
of  an  emetic.  lu  a  case  where  the  symptoms  of  congestion  had 
developed  rapidly,  and  especially  where  there  was  marked  coma, 
the  action  of  the  emetic  would  be  the  most  speedy,  and  probably 
the  most  certain.  The  acetous  emetic  tincture  is  the  best 
emetic  in  such  cases,  being  very  thorough  in  its  action,  and  also 
giving  the  stimulant  influence  upon  the  circulation.  I  ad- 
minister it  in  doses  of  gtt.  x.  to  xx.  every  ten  minutes,  with  some 
stimulant  or  aromatic  infusion,  and  continue  to  repeat  it  until 
very  thorough  emesis  is  induced,  and  a  free  circulation  of  blood 
follows.  The  nervous  prostration  and  coma  are  usually  overcome 
by  this  action,  and  in  many  cases,  after  such  thorough  emetic, 
the  disease  will  run  the  usual  course  of  a  simple  remittent  fever. 

Should  the  symptoms  of  congestion  return,  the  emetic  may  be 
repeated  every  day,  or  even  twice  daily.  In  these  severe  cases  I 
like  the  action  of  the  hot  blanket  pack,  as  an  adjuvant  to  the 
other  treatment.  To  a  kettle  of  hot  water  add  an  ounce  of 
mustard,  wring  a  blanket  out  of  it,  and  wrap  the  child  up  in  it, 
placing  it  in  bed,  and  covering  warmly.  In  half  an  hour  the 
wet  blanket  may  be  replaced  by  a  hot  dry  one,  in  which  the  child 
can  remain  until  the  means  employed  are  successful. 

Another  very  efficient  means  of  revulsion  is — heat  three, 
four,  or  five  bricks  on  the  fire  until  they  are  hot  enough  to 
vaporize  water,  yet  not  to  burn  the  clothing ;  wrap  them  in 
cloths  wrung  out  of  equal  parts  of  vinegar  and  water,  and  place 
them  at  the  feet,  legs  and  body  of  the  child,  covering  the  whole 
loosely  with  a  blanket,  which  should  be  well  tucked  in  at  the 
feet  and  around  the  child's  shoulders,  to  prevent  the  escape  of 
the  vapor.  It  is  very  efficient  as  described,  but  may  be  rendered 
more  powerful  by  the  addition  of  tincture  of  Capsicum  to  the 
vinegar  and  water  in  which  the  cloths  are  wet. 

The  above  may  be  called  the  indirect  method  of  treatment,  and, 
as  will  be  seen,  requires  considerable  skill,  and  much  attention 
from  the  nurse.  For,  when  improperly  used,  it  may  do  as  much 
harm  as  it  would  do  good  if  used  rightly. 

The  direct  method  is  wholly  different,  but  to  persons  in  tlie 
habit  of  active  medication  will  hardly  seem  sufficient  for  the 
purpose.  The  remedy  with  which  I  propose  to  overcome  the 
congestion,  is  Belladonna,  in  small  doses.  I  generally  administer 
it  with  Aconite.  I^  Tinct.  Aconite,  Tinct.  Belladonna,  aa.  gtt. 
v.,  water  5iv. ;  a  teaspoonful  evci-y  hour.     Had  I  not  seen  the 


CONGESTIVE   FEVEE.  163 

specific  action  of  Belladonna  in  sncli  cases  so  frequently,  I  would 
not  be  willing  to  give  it  this  recommendation.  But  if  my  ex- 
perience is  to  be  depended  upon,  the  remedy  is  most  reliable,  and 
will  give  entire  satisfaction. 

In  this  connection  a  very  important  part  of  the  treatment  will 
be  stimulants  and  restoratives,  and  I  shall  refer  to  Elixir  of 
Guarana,  Conip.  Spirits  of  Lavender  and  beef  essence.  They 
have  filled  the  requirements  so  often  that  I  consider  them  indis- 
pensable in  these  prostrating  diseases. 

Usually,  in  these  cases,  I  continue  the  same  remedies  through- 
out the  treatment,  as  there  is  still  some  tendency  to  congestion  or 
feebleness  of  the  capillary  eirculation,  especially  of  the  brain. 

In  congestion  of  the  respiratory  apparatus,  in  addition  to  the 
means  named,  or  when  it  is  a  special  lesion,  other  parts  not  suf- 
fering so  much,  I  depend  principally  upon  small  doses  of  Lobelia 
internally.  For  a  child  three  to  six  months  of  age  we  may 
prescribe:  ]^  Tinct.  of  Lobelia  (seed)  5j-,  Compound  Tinct.  of 
Lavender  5ij-,  Simple  Syrup  Sij.  Dose,  half  teaspoon ful  every 
fifteen  minutes  or  half  hour. 

For  the  local  application  I  direct  a  cloth,  sufficiently  large  to 
cover  the  anterior  surface  of  the  thorax,  spread  with  lard  and 
dusted  with  Comp.  Powder  of  Lobelia  and  Capsicum.  This  is 
changed  once  or  twice  daily  until  the  complication  is  removed. 

In  congestion  of  the  abdominal  viscera  I  order  hot  stimulant 
fomentations  to  the  bowels,  occasionally  preceded  by  dry  cupping 
if  the  child  is  of  some  age,  and  an  enema  of  an  infusion  of  Bay- 
berry,  to  which  is  added  one  drachm  of  tincture  of  Lobelia.  The 
enema  as  named,  is  of  especial  importance  in  those  sev^ere  cases 
in  which  the  danger  is  imminent  and  speedy  relief  essential. 

In  congestion  of  the  kidneys  I  apply  hot  fomentations  across 
the  loins,  sometimes  preceded  by  dry  cups,  and  move  the  bowels 
freely  by  the  use  of  an  enema  of  Comp.  Powder  of  Jalap  and 
Senna.  In  those  cases  in  which  there  is  a  constant  tendency  to 
congestion  of  these  organs,  but  in  which  the  urine  is  not  sup- 
pressed to  any  considerable  extent,  Santonine,  gr.  one-sixth  to 
one-fourth  every  three  hours,  will  prove  effectual. 

In  all  other  respects  the  fever  should  be  treated  in  the  same 
manner  as  named  for  infantile  remittent.  In  those  cases  in  which 
the  abdominal  organs  are  principally  aifected,  the  sulphate  of 
qninia  combined  Avith  warm  olive  oil,  and  the  abdominal  organs 
thoroughly  bathed  with  it  and  rubbed  gently  three  or  four  times 


164  DISEASES  OF    CHILDREN. 

daily,  will  give  prompt  relief.  Too  much  importance  can  not  be 
attached  to  this  kneading  and  friction  process,  it"  supplies  a  long 
needed  want  in  medical  treatment,  particularly  in  congestion 
and  some  other  diseases,  as  marked  beneficial  results,  after  re- 
peated trials  in  practice,  have  proven.  In  those  cases  where  an 
acid  is  required,  I  would  always  combine  the  quinia  with  it, 
adding  aromatic  elixir  to  form  a  pleasant  preparation.  The  sul- 
phite of  soda  will  also  prove  a  very  important  remedy  in  some 
of  these  cases — the  tongue  presenting  that  peculiar  broad,  pale, 
pasty  condition,  heretofore  named  as  indicating  it. 

CONTINUED   FEVER. 

As  heretore  noticed,  continued  fever  is  not  of  frequent  occur- 
rence in  early  life;  and,  up  to  the  fifth  year,  the  common  fevers 
of  children  are  those  already  described.  Indeed,  with  but  ex- 
ceptional cases,  we  will  not  meet  with  continued  fever,  except  in 
those  years  in  which  it  is  the  prevailing  disease  of  the  adult, 
being  endemic  or  epidemic.  At  such  times  the  cause  of  con- 
tinued fever  is  very  intense,  and  influences  the  child  as  well  as 
the  adult.  A  continued  fever  is  never  sthenic  in  childhood.  In 
the  majority  of  cases  it  will  present  the  symptoms  of  synochoid,  or 
common  continued  fever,  and  only  when  the  cause  of  typhoid  fever 
is  intense,  do  we  have  this  form  of  the  disease  with  the  intestinal 
complication.  Typhoid  symptoms,  i.  e.,  the  evidences  of  de- 
pression and  sepsis  of  the  blood,  is,  however,  of  tolerably  fre- 
quent occurrence. 

Causes. — We  accept  the  usual  theory,  that  this  class  of  fevers 
is  caused  by  an  animal  poison,  or  malaria.  What  it  is  exactly 
we  do  not  know,  but  that  animal  matter  in  certain  states  of  de- 
composition will  produce  fever  of  this  kind,  is  very  clearly 
proven.  The  fever  poison  may  be  generated  by  decaying  animal 
matter,  or  by  a  person  suifering  from  such  disease,  and  being 
introduced  into  the  circulation  through  the  lungs,  or  the  ordinary 
methods  of  absorption,  sets  up  a  process  of  change  which  gives 
us  the  phenomena  of  fever. 

Pathology. — As  just  stated,  the  cause  of  continued  fever 
is  an  organized  body  undergoing  decomposition.  It  may  be  per- 
ceptible to  the  senses,  or  it  may  be  in  gaseous  form,  but  it  pos- 


CONTINUED    FEVEB.  165 

sesses  the  property  of  setting  up  a  like  change  in  any  material 
that  possesses  its  elements  with  which  it  may  come  in  contact. 

The  theory  of  Liebig  is,  that  the  fever  poison  resembles  yeast 
in  this  respect,  and  that  it  not  only  sets  up  a  process  of  decom- 
position in  the  blood,  but  develops  a  material  similar  to  itself 
out  of  its  elements.  The  evidence  of  this  action  is  so  marked 
and  so  well  known  that  it  is  not  now  a  matter  of  controversy. 

The  fever  poison  possesses  varying  degrees  of  intensity,  just 
as  yeast  is  weak  and  active.  Like  this,  also,  it  possesses  the 
power  of  setting  up  these  changes  in  minute  as  well  as  in  large 
quantity.  "When  the  fever  poison  is  active  we  find  it  producing 
fever  of  a  grave  character,  which  either  runs  its  course  rapidly 
to  a  fatal  termination,  or  is  prolonged  and  attended  with  great 
prostration.  On  the  contrary,  when  the  fever  poison  is  mild,  the 
fever,  though  it  may  be  protracted,  is  not  of  a  grave  character. 

These  fevers  are  characterized  by  the  length  of  their  forming 
stage,  or  period  of  incubation.  During  this  time  the  fever  poi- 
son is  insidiously  undermining  the  powers  of  life.  Digestion  is 
influenced  by  it,  as  is  assimilation  and  the  formation  of  blood. 
Every  molecule  that  is  formed  into  tissue  during  this  period,  re- 
ceives the  impress  of  the  poison  in  an  imperfect  development ; 
and  it  is  not  until  the  patient  is  divested  of  all  these  imperfect 
tissues  that  real  convalescence  commences. 

Post-mortem  examination  reveals  the  same  lesions  that  are 
found  in  the  adult.  There  is  marked  change  in  the  blood,  both 
of  the  albumen,  fibrin,  and  red  globules.  It  does  not  coagulate 
firmly,  does  not  change  readily  when  brought  in  contact  with 
oxygen,  and  the  microscope  shows  the  red  globules  more  or  less 
broken  down.  There  is  no  special  lesion  of  structure,  except  in 
those  cases  in  which  the  glands  of  Peyer  are  involved,  and  these 
have  presented  the  characteristic  symptoms  of  typhoid  fever 
during  life. 

Symptoms. — One  of  the  most  marked  features  of  a  continued 
fever,  is  the  long  duration  of  the  forming  stage,  which  frequently 
embraces  from  one  to  three  Aveeks.  During  this  time  the  child 
will  be  dull,  uneasy  and  fretful  at  times,  will  sleep  more  during 
the  day,  and  will  be  restless  and  wakeful  at  night.  Its  appetite 
will  be  impaired,  the  bowels  irregular,  and  the  skin  dryer  than 
usual.  The  tissues  become  soft  and  flaccid,  and  it  loses  strength 
in  a  marked  degree. 


166  DISEASES  OP  CHILDEEN. 

The  chill-  is  usually  protracted.  In  many  cases  an  entire  day, 
sometimes,  indeed,  two  days  will  be  occupied  with  alternate  slight 
chills  and  febrile  exacerbations.  Slowly  the  fever  becomes  estab- 
lished, and,  to  the  ordinary  observer,  it  does  not  seem  so  severe 
as  in  the  simple  febricula,  or  infantile  remittent,  but  the  experi- 
enced practitioner  sees  in  the  prostration  of  the  nervous  system, 
the  feeble  circulation  of  the  blood,  the  parchment-like  skin,  and 
the  marked  debility,  evidences  of  a  grave  lesion. 

Day  by  day,  as  the  fever  advances,  the  strength  becomes  more 
impaired;  the  pulse  is  more  frequent,  is  smaller  and  harder,  or 
more  frequently  soft  and  easily  compressed  ;  the  skin  is  dry  and 
harsh,  and  manifestly  inactive ;  the  urine  is  tolerably  free,  but  is 
pale,  frothy,  and  has  an  unpleasant  odor  ;  the  stools  are  also  fre- 
quently papescent,  and  have  an  unpleasant  odor ;  the  nervous 
system  is  markedly  implicated.  In  some  cases  the  patient  is  very 
restless  and  irritable,  the  eyes  bright  and  the  pupils  dilated ;  but 
in  the  majority  the  patient  is  dull,  the  face  is  expressionless,  the 
eyes  dull,  and  the  child  dozes  with  its  eyes  half  open. 

Passing  on  toward  the  eighth  or  the  tenth  day,  we  notice  that 
the  child's  mind  wanders,  though  there  is  never  the  manifest 
delirium  that  we  witness  in  the  adult.  In  other  cases  the  dull- 
ness has  passed  into  coma,  which  gradually  deepens  until  it  ter- 
minates the  life  of  the  patient. 

The  tongue  shows  distinctly  the  character  of  the  disease.  In 
a  majority  of  cases  it  is  contracted,  its  movement  is  impaired, 
and  the  coating  upon  it  has  a  tinge  of  brown.  In  this  case  the 
tongue  and  mucous  membrane  of  the  mouth  are  of  a  dull-red  or 
dusky  hue,  which  once  observed  will  always  convey  to  the  mind 
the  evidence  of  depravation  of  the  blood.  In  a  much  smaller 
number  of  cases,  the  tongue  is  broad  and  pale,  and  covered  with 
a  pasty  white  coat. 

In  the  first  case,  as  the  disease  advances,  the  tongue  becomes 
dryer,  less  mobile,  fissured,  and  the  coating  of  a  deeper  brown, 
until  finally,  in  the  severer  cases,  it  is  dry,  black,  and  fissured, 
can  not  be  protruded  or  hardly  moved  in  the  mouth,  and  bleeds 
when  it  comes  in  contact  with  anytliing,  or  even  when  movement 
is  attempted.  I  am  of  the  opinion  that  this  condition  is  due 
rather  to  the  harsh  medication  so  frequently  adopted,  than  to  the 
disease. 

When  the  symptoms  above  are  most  marked,  the  passages  of 
the  nose  and  the  throat  are  also  involved,  and  in  consequence 


CONTINUED  FEVEE.  167 

there  is  a  dry  whistling  respiration,  sometimes  with  much  diffi- 
culty. The  lips  also  are  dry,  fissured,  bleed,  and  form  dark  un- 
pleasant-looking crusts. 

The  symptoms  of  typhoid  fever  have  the  addition  of  the  intes- 
tinal lesion.  Early  in  the  disease  the  bowels  become  lax,  which 
by  the  fourth  or  fifth  day  is  a  marked  dirrrhoea ;  there  is  also  the 
evidence  of  pain  in  the  bowels,  and  tenderness  on  pressure.  A 
peculiar  pinched  appearance  of  the  face  is  frequently  seen,  and 
may  almost  be  regarded  as  pathognomonic  of  this  condition. 

As  the  disease  advances  the  intestinal  complication  is  the 
most  marked  feature.  The  diarrhoea  is  very  intractable,  with 
evident  pain  and  uneasiness  before  the  evacuations.  The  dis- 
charges present  an  unpleasant  appearance  and  an  unusual  fetor. 
Occasionally  there  is  tympanitis. 

The  natural  duration  of  the  disease  is  from  three  to  four  weeks, 
though  in  some  cases  it'  may  terminate  fatally  by  the  end  of  the 
first  week,  and  by  appropriate  treatment  it  may  be  aborted  in 
the  early  part  of  its  course.  During  this  period  it  may  be  com- 
plicated with  local  diseases,  as  named  under  the  head  of  infantile 
remittent,  but  as  they  present  very  nearly  the  same  symptoms, 
and  possess  the  same  pathological  character,  they  need  not  be 
further  described. 

Diagnosis. — We  determine  the  character  of  this  fever,  first, 
by  the  long  duration  of  its  forming  stage,*  and  the  nervous  pros- 
tration at  the  period  of  chill  and  commencement  of  febrile  reac- 
tion. As  it  progresses,  the  continued  febrile  reaction,  without 
remission,  gives  it  a  distinctive  character. 

The  typhoid  form  of  continued  fever  is  diagnosed  by  the  ap- 
pearance of  diarrhoea  early  in  the  disease,  with  tenderness  on 
pressure  about  the  umbilicus,  and  evident  intestinal  uneasiness, 
if  not  pain.  In  these  cases,  also,  the  fever  is  of  an  asthenic  type, 
and  there  is  especial  prostration  of  the  nervous  system. 

Prognosis. — The  prognosis  is  not  unfavorable  if  the  disease 
is  properly  treated ;  but  under  the  old  antiphlogistic  treatment 
the  mortality  was  sometimes  large.  Indeed,  if  patients  are  care- 
fully nursed,  and  have  proper  food,  the  disease  being  allowed  to 
run  its  regular  course,  the  mortality  will  not  be  more  than  ten 
per  cent. 

Treatment. — The  object  of  treatment  in  this  disease  is  two- 
fold— to  shorten  its  duration,  and  relieve  unpleasant  symptoms. 


168  DISEASES  OP  CHILDREN. 

Tn  some  few  cases  we  may  save  life,  but  they  must  be  few,  as  the 
mortality  is  but  small,  and  some  of  the  deaths  are  unavoidable, 
as  the  disease  involves  all  the  tissues  of  the  body,  which  must 
be  removed  before  convalescence  is  completely  established.  With 
simple  functional  lesion  we  might  expect  to  avrest  the  disease  at 
once;  but  we  are  doing  well  to  accomplish  it  by  the  seventh 
to  the  ninth,  or  sometimes  the  twenty-first  day. 

As  heretofore  named,  the  first  indication  of  cure  is  to  correct 
the  functional  disturbance,  for  this  must  precede  the  removal  of 
structural  lesions.  The  derangement  of  the  circulation  of  blood 
is  manifestly  first  in  order,  and  if  we  can  correct  it,  other  indica- 
tions of  treatment  will  be  readily  accomplished. 

I  prescribe  in  this  case,  as  in  other  fevers,  the  special  sedatives, 
as :  '^i  Tinct.  Aconite,  or  Tinct.  Veratrum,  gtt.  v.,  water  5iv., 
a  teaspoonful  every  hour.  This  is  continued  to  the  complete 
establishment  of  convalescence,  whatever  additional  means  may 
be  employed. 

If  there  is  irritation  of  the  nervous  system,  with  flushed  face, 
restlessness,  sleeplessness,  and  other  evidences  of  determination 
of  blood,  we  give  Gelseminum  in  combination  with  the  sedatives ; 
but  if  on  the  contrary  there  is  dullness  and  hebetude,  the  patient 
being  drowsy,  sleeping  with  the  eyes  part  open,  and  as  the  dis- 
ease progresses  tending  to  coma,  we  use  Belladonna  instead,  as: 
^  Tinct.  of'  Belladonna,  Tinct.  of  Aconite,  aa.  gtt.  v.,  water 
Siv.,  a  teaspoonful  every  hour. 

The  patient  has  a  sponge  bath  once  or  twice  daily,  always  used 
carefully  so  that  the  surface  will  not  be  chilled.  Sometimes  we 
find  it  better  not  to  employ  the  bath  after  the  first  two  or  three 
days,  on  account  of  the  prostration  that  follows.  The  hot  foot- 
bath is  both  an  aid  to  the  action  of  the  sedatives,  and  valuable 
to  relieve  irritation  of  the  nervous  system  and  produce  sleep. 
When  there  is  great  wakefulness  we  render  it  more  stimulant  by 
the  addition  of  mustard  or  capsicum. 

There  are  some  cases,  though  in  most  seasons  but  few,  in 
which  decided  benefit  will  follow  th6  use  of  an  emetic  in  the 
early  stage  of  the  disease ;  indeed,  occasionally  it  offers  the  only 
safe  course.  The  cases  are  those  in  which  the  tongue  is  broad, 
covered  with  a  heavy  yellowish  white  fur,  especially  at  its  base. 
The  breath  is  frequently  fetid  ;  there  is  nausea  and  retching, 
and  medicines  are  rejected  by  vomiting,  or,  if  retained,  are  not 
absorbed.     In   such  cases   deterioration   of  the  blood   goes   on 


EEMITTENT  FEVER.  169 

rapidly,  and  typhoid  symptoms  are  developed  early.  A  thorough 
emetic  of  acetous  emetic  tincture,  or  Ipecacuanha,  removes  ac- 
cumulations from  the  stomach,  stimulates  it  to  better  action, 
and  prepares  the  way  for  the  successful  administration  of  other 
remedies,  and  the  digestion  of  food. 

There  is  yet  another  condition  in  which  an  emetic  can  be  em- 
ployed with  marked  advantage.  I  allude  to  those  cases  in  which 
there  is  marked  nervous  prostration,  with  dull  eyes,  expression- 
less countenance,  tendency  to  sleep,  which  will  soon  pass  into 
coma.  In  these  cases  the  action  of  the  emetic  arouses  the  nerv- 
ous system,  and  at  the  same  time  gives  a  better  and  more  equal 
circulation  of  blood. 

When  the  tongue  is  pallid,  usually  with  a  whitish  pasty  coat, 
I  like  the  action  of  the  alkaline  sulphites.  The  sulphite,  or 
hyposulphite  of  soda  is  in  most  common  use,  and  may  be  given 
in  doses  of  five  grains  every  three  hours  to  a  child  two  years  old. 
It  may  be  commenced  at  the  beginning  of  the  treatment,  and 
used  Avith  the  special  sedatives.  It  is  discontinued  when  the 
condition  for  which  it  has  been  given  is  removed.  Frequently 
a  day  will  make  such  a  difference  in  the  patient,  especially  after 
the  remedy  has  been  given  for  three  or  four  Jdays,  that  we  will 
find  it  necessary  to  put  the  patient  upon  the  use  of  an  acid. 

When  the  mucous  membranes  are  dark-red,  or  dusky,  the 
tongue  being  in  a  majority  of  cases  dry  and  contracted  (occasion- 
allly  it  is  moist),  I  give  the  muriatic  acid  from  the  commencement 
of  the  treatment,  using  the  formula  heretofore  given:  1^  Dilute 
Muriatic  Acid,  5ij-i  Simple  Syrup,  .^ij.  Add  it  to  water  so  as  to 
make  it  pleasantly  acid,  and  give  as  a  drink.  The  child  can 
hardly  take  too  much ;  usually  about  one  teaspoonful  of  the 
mixture  every  two  hours  will  be  the  proper  quantity. 

There  are  some  cases  in  which  irritation  of  the  stomach,  will  be 
an  unpleasant  feature  in  the  early  part  of  the  disease.  Not  only 
so,  but  it  will  aggravate  all  the  symptoms,  prevent  the  action  of 
remedies,  and  cause  the  disease  to  run  a  more  rapid  course,  and 
increase  its  fatality. 

This  irritation  should  be  arrested  early.  So  important  is  this, 
that  it  will  take  precedence  of  all  other  treatment.  I  generally 
prescribe  a  cold  application — cloths  wrung  out  of  cold  water,  or 
its  opposite — hot  fomentations  applied  over  the  whole  abdomen. 
An  infusion  of  the  bark  of  the  young  limbs  of  the  peach-tree,  in 
small  doses,  is  very  efficient  in  quieting  this  irritation.     In  other 


170  DISEASES  OF  CHILDEEN. 

cases,  the  subnitrate  of  bismuth,  in  mint  water,  may  be  employed. 
An  infusion  of  the  compound  powder  of  rhubarb,  given  in  small 
doses,  has  answered  a  good  purpose,  sometimes  continuing  the 
remedy  until  it  produces  a  slight  laxative  effect. 

In  this  case.  Aconite  alone  of  the  sedatives  may  be  used,  with 
the  addition  of  Gelseminum,  if  there  is  irritation  of  the  nerve- 
centers,  or  Ipecac  if  there  is  intestinal  irritation.  The  dose  is 
five  drops  of  the  Aconite  to  four  ounces  of  water. 

Cathartics  are  not  employed  in  this  fever,  unless  there  are 
special  indications  for  their  use.  This  would  be,  evident  accu- 
mulations in  the  intestinal  canal,  and  irritation  from  this  cause. 
The  usual  evidence  from  the  tongue,  is  its  uniform  yellowish 
coat,  extending  from  base  to  tip. 

With  the  means  already  named,  judiciously  selected  to  meet 
the  indications  of  the  case,  we  find  the  patient  progressing  favor- 
ably. The  disease  yields,  day  by  day — the  pulse  becomes  less 
frequent,  but  is  greater  in  volume  and  in  freedom  of  circulation — 
the  irritation  or  depression  of  the  nervous  system  passes  away, 
and  the  secretions  are  gradually  established.  In  a  majority  of 
cases,  no  other  medicines  will  be  required,  as  with  proper  nursing 
and  food  all  symptoms  of  febrile  disturbance  will  have  passed 
away  by  the  seventh  to  the  fourteenth  day. 

In  a  few  cases  we  will  find  it  necessary  to  stimulate  secretion 
from  the  skin  and  kidneys,  after  the  sedative  has  produced  its 
effect.  The  Comp.  Powder  of  Ipecac  and  Nitrate  of  Potash,  will 
be  found  a  good  remedy  for  this  purpose,  and  will  also  act  very 
kindly  on  the  nervous  system,  and  promote  rest  and  natural  sleep. 

Occasionally  we  are  called  to  take  charge  of  cases  of  fever 
which  have  run  the  first  part  of  their  course,  and  have  some- 
limes  been  aggravated  by  the  medicines  employed.  All  forms 
of  fever  will,  if  severe,  or  badly  managed,  present  much  the 
same  lesions  and  symptoms ;  these  being  of  an  asthenic  or 
typhoid  type. 

In  diagnosis,  as  well  as  in  our  therapeutics,  we  group  them  in 
four  classes — with  reference  to  the  circulation — with  reference  to 
digestion  and  the  formation  of  blood — with  reference  to  the 
nervous  system — and  with  reference  to  waste  and  excretion. 

The  action  of  the  heart  is  rapid,  but  imperfect,  and  though 
the  blood  apparently  moves  faster,  there  is  deficient  circulation 
in  the  capillaries.  Here  small  doses  of  the  special  sedatives 
exert  a  most  marked  influence.     As  the  pulse  becomes  less  fre- 


CONTINUED  FEVER.  171 

quent  under  their  influence,  the  action  of  the  heart  is  stronger 
and  more  regular,  and  the  blood  circulates  more  freely,  and  is 
more  equally  distributed.  In  the  majority  of  these  cases  we 
prefer  the  use  of  Aconite,  but  are  governed  even  in  this  ad- 
vanced stage  by  the  rules  already  laid  down. 

It  is  of  very  great  importance  to  the  success  of  treatment  at 
this  advanced  stage,  that  the  stomach  be  placed  in  condition  to 
receive  and  digest  small  portions  of  food,  for  the  real  danger  is, 
many  times,  from  starvation — a  failure  of  vital  power,  from  a 
want  of  nutrient  material  to  sustain  it. 

One  of  two  conditions  will  usually  present — the  tongue  will 
be  contracted,  dry,  fissured,  and* coated  brown  or  black;  the  lips, 
also,  will  be  dry,  and  occasionally  covered  with  an  unpleasant 
crust.  The  mucous  membrane  of  the  mouth,  tongue,  nose,  etc., 
is  dark-red  or  dusky.  In  this  case,  we  administer  dilute  muri- 
atic acid,  as  heretofore  named,  giving  it  as  a  drink,  and  as  freely 
as  the  child  chooses  to  take  it.  In  the  other  case,  the  tongue  is 
broad,  pallid,  and  moist,  and  covered  with  a  pasty  fur.  Here 
we  give  sulphite  of  soda,  in  the  usual  doses.  For  the  use  of  the 
anti-zymotics  the  reader  is  referred  to  page  95. 

To  improve  innervation,  and  get  its  general  influence  upon 
the  system,  I  like  the  action  of  quinine  used  by  inunction.  In- 
ternally, it  is  not  kindly  borne  at  this  stage  of  the  disease.  We 
find  also,  that  this  fatty  inunction  improves  the  condition  of  the 
skin,  and  also  increases  the  general  vital  power  of  the  child. 

The  food  of  the  child  will  be  boiled  milk,  with  sufficient  salt 
to  make  it  pleasant.  It  is  more  kindly  •received  and  better  di- 
gested, if  taken  quite  warm,  the  heat  acting  as  a  stimulant  to  the 
stomach.  Children  take  food,  because  they  have  an  appetite  or 
desire  for  it,  and,  not  as  the  adult  sick  may,  because  their  reason 
shows  the  necessity  of  it.  In  disease,  when  there  is  no  appetite, 
but  on  the  contrary,  disgust  for  food,  they  can  not  sometimes  be 
persuaded  to  take  it  in  the  usual  manner  of  taking  food.  In  such 
cases,  instead  of  letting  them  sufi^er  from  the  want  of  it,  I  have 
the  milk  given  as  a  drink,  even  sometimes  mixed  with  one  or 
two  parts  of  water.  The  necessity  of  this  attention  to  giving 
food  should  be  forcibly  impressed  upon  the  mother. 

If  the  child  Avill  not  take  milk,  we  may  have  preparations  of 
arrow-root,  sago,  tapioca,  maizena,  etc.,  or  occasionally  a  beef 
essence  will  answer  a  good  purpose.  A  good  way  to  make  a  beef 
tea  for  a  child,  or  even  an  adult,  is  as  follows :     Cut  a  lean  and 


172  DISEASES  OF    CHILDEEN. 

tender  piece  of  beef  in  small  pieces,  rejecting  all  the  fat ;  put  in 
a  tin  or  porcelain-lined  vessel  and  cover  with  cold  water;  set 
on  the  stove  and  bring  it  slowly  to  the  boiling  point,  letting  it  boil 
for  half  an  hour.  We  thus  get  the  elements  of  the  beef  in  a  fluid 
form,  and  with  the  necessary  salt  it  will  be  quite  palatable. 

The  attention  to  the  skin,  by  Ihe  quinine  inunction,  or  an 
occasional  stimulant  bath,  with  brisk  friction,  will  be  all  that  we 
can  do  to  get  secretion  from  this  organ.  As  a  general  rule,  it 
will  not  be  good  policy  to  stimulate  the  kidneys  by  special  means, 
at  this  advanced  stage  of  the  disease.  Occasionally,  when  con- 
valescence is  being  established,  we  may  administer  a  saline 
diuretic  in  small  quantity,  to  facilitate  the  removal  of  waste.  The 
tincture  of  muriate  of  iron,  recommended  to  aid  convalescence, 
strengthens  and  increases  the  action  of  the  kidneys.  As  a  gen- 
eral rule,  the  bowels  had  better  not  be  interfered  with.  But 
where  there  is  irritation  from  accumulations  in  the  intestinal 
canal,  a  gentle  purgative  of  compound  powder  of  rhubarb  will 
answer  a  good  purpose.  In  those  cases  in  which  the  tongue  is 
broad  and  pale,  minute  doses  of  Podophyllin,  triturated  as  here- 
tofore described,  may  be  used  with  advantage.  Occasionally  we 
associate  one-fourth  to  one-half  grain  of  hydrastis  with  it. 

In  some  few  cases,  there  is  tardy  passage  of  urine,  or  complete 
retention,  and  if  this  is  not  seen  to,  it  will  lead  to  a  fatal  termi- 
nation. The  use  of  diuretics,  as  generally  advised,  is  bad  prac- 
tice. Instead,  I  prescribe  santonine,  triturated  with  sugar,  in 
doses  of  one-sixth  to  one-fourth  gr.  every  hour,  until  the  patient 
is  relieved.     Its  action  m  this  respect  is  specific. 

In  some  other  cases,  the  urine  is  suppressed,  producing  at  first 
irritation  of  the  nervous  system,  then  coma,  which  gradually 
deepens  until  the  child  dies.  In  other  cases,  convulsions  ensue, 
and  the  patient  dies  of  them.  In  this  case,  also,  I  do  not  depend 
upon  diuretics.  Instead,  I  have  hot  fomentations  applied  assidu- 
ously across  the  lions.  Usually  the  fomentation  is  of  vinegar 
and  water;  but  if  there  is  evident  congestion,  it  may  be  rendered 
stimulant. 

SPOTTED    FEVEK. 

Though  not  a  disease  of  childhood  exclusively,  yet  it  has  pre- 
vailed among  children  more  than  adults,  and  deserves  considera- 
tion here."  Indeed,  if  we  were  to  reject  all  the  diseases  Avliicli 
attack  the  adult  as  well,  we  would  have  but  a  small  list  remaining. 


SPOTTED   FEVEE.  173 

Spotted  fever  has  prevailed  in  this  country  to  a  very  considera- 
ble extent  since  1862.  In  some  localities  it  seemed  endemic, 
while  in  others  it  was  decidedly  epidemic.  Whether  or  not  it  is 
contagious  has  been  in  dispute ;  some  contending  that  it  is, 
others  that  it  is  not.  My  own  opinion  is  that  spotted  fever  is, 
in  ordinary  cases,  contagious,  like  typhoid  fever;  that  when 
very  malignant,  with  marked  symptoms  of  putrescency,  a  fever 
poison  is  evolved  which  will  affect  persons  who  come  in  contact 
with  it.  There  is,  again,  an  epidemic  form  in  which  the  conta- 
gion is  as  marked  as  in  typhus  fever. 

Many  have  supposed  that  spotted  fever  was  a  new  disease, 
bearing  no  relation  to  diseases  known  and  described  by  authori- 
ties, and  have  been  at  a  loss  how  to  treat  it.  The  fact  is  the 
disease  has  appeared  several  times  previously,  and  bears  a  very 
close  relationship  to  typhus  fever,  with  the  addition  of  a  sub- 
acute cerebro-spinal  meningitis. 

This  fever  first  made  its  appearance  in  this  countiy  in  the  town 
of  Medway,  Massachusetts,  in  the  year  180G,  and  prevailed  to  a 
considerable  extent  in  New  England  from  that  time  up  to  1815. 
At  this  time  it  presented  the  same  symptoms,  was  as  malignant, 
and  attended  by  the  same  mortality. 

The  same  disease  is  noticed  by  historians  as  having  prevailed 
over  the  greater  part  of  Europe  in  1505,  1528, 1556,  and  at  vari- 
ous times  up  to  1805 ;  and  we  can  trace  it  under  the  names  of 
hospital,  jail,  putrid,  or  spotted  fever,  in  almost  all  parts  of  the 
world  during  the  last  century,  following  in  the  train  of  the 
great  European  armies,  among  which  it  made  the  most  destruc- 
tive ravages,  and  by  whom  it  was  spread  over  the  greater  part 
of  Europe. 

Cause. — The  cause  of  spotted  fever  is  undoubtedly  an  animal 
poison  of  very  great  activity,  resembling  in  many  respects  the 
fever  poison  or  malaria  of  typhus.  We  do  not  know  definitely 
how  it  was  produced  in  this  country ;  yet  in  all  previous  epidem- 
ics it  has  been  traced  to  crowding,  bad  ventilation,  and  especially 
to  the  decomposition  of  human  excreta. 

Pathology. — In  its  pathology  this  fever  does  not  differ  very 
materially,  save  in  its  malignancy  and  rapidity,  from  that  last 
considered.  The  fever  poison,  whatever  it  may  be,  when  once 
introduced  into  the  blood,  reproduces  itself  more  or  less  rapidly, 
and  finally  causes  the  death  of  this  fluid.     In  some  cases  the 


174  DISEASES   OF  CHILDREN. 

virulence  is  such,  that  within  forty-eight  or  even  twenty-four 
hours,  the  blood  is  completely  broken  down,  dies  even  before  the 
vital  functions  have  ceased. 

Post-mortem  examination  reveals  a  breaking  down  of  the 
blood  in  greater  degree  than  in  typhoid  fever.  There  is  also 
extravasation  of  blood,  and  especially  of  its  coloring  material,  so 
that  parts  which  were  congested  during  life  are  much  discolored, 
as  are  the  most  dependent  parts  of  the  body  after  death.  Parts 
that  have  suffered  from  local  congestion  are  also  softened,  some- 
times so  much  so  that  they  may  be  readily  separated  and  broken 
with  the  handle  of  the  scalpel. 

The  spleen  is  engorged  with  dark  grumous  and  broken  down 
blood,  and  is  frequently  enlarged.  The  liver  is  also  dark-colored, 
swollen,  and  friable.  The  lungs  seem  to  have  suffered  in  like 
manner,  are  filled  with  blood,  and  the  bronchial  tubes  contain  a 
dark-colored  offensive  mucus. 

The  surface  of  the  body  presents  in  some  cases  a  remarkably 
spotted  or  ecchymosed  condition.  The  discolorations  are  purplish 
or  almost  black,  and  most  numerous  on  the  most  dependent  parts 
of  the  body.  A  close  examination  reveals  that  they  are  true 
ecchymoses  or  vibices. 

Symptoms. — The  symptoms  vary  in  different  cases  and  in 
different  localities,  but  may  be  divided  into  two  prominent 
classes,  as  follows : 

First.  For  two  or  three  days  the  patient  is  listless,  dull,  and 
stupid,  the  face  is  flushed  and  dusky,  eyes  tumid,  some  pain  in 
the  head  and  back,  loss  of  appetite,  tongue  dusky-red  and  coated 
with  a  dirty-white  mucus,  skin  dry.  This  is  the  forming  stage 
of  the  disease,  and  instead  of  lasting  as  long  as  named,  will,  in 
the  severer  cases,  not  be  longer  than  twenty-four  hours. 

Following  this  there  is  a  tolerably  well-marked  chill,  lasting 
for  two  or  three  hours,  and  attended  with  great  prostration. 
Febrile  reaction  follows,  sometimes  high,  at  others  not  very  well 
marked.  In  the  one  case  the  surface  becomes  intensely  hot  and 
flushed,  the  pulse  120  to  140  in  the  adult,  and  so  that  it  can 
scarcely  be  counted  in  the  child,  sharp  and  hard,  with  great  irri- 
tability and  restlessness,  though  there  is  marked  dullness  of  the 
intellectual  functions.  The  thermometer  marks  a,  temperature 
in  these  cases  of  from  104  to  109  degrees.  The  urine  is  scanty 
and  tlie  bowels  constipated.  Frequently  there  is  difficult  respi- 
ration, some  cough,  and  sibilant  rales. 


SPOTTED   FEVER.  175 

111  from  two  to  six  days  an  eruption  appears  upon  the  surface, 
very  closely  resembling  measles,  but  more  clearly  defined.  If 
the  patient  recovers  they  commence  fading  out  by  the  end  of  the 
frrst  twenty-four  hours,  but  do  not  disappear  entirely  for  some 
days.  If  the  disease  progresses  unfavorably,  they  become  dusky, 
and  at  last  livid  and  associated  with  vibices.  As  their  color  be- 
comes darker  the  nervous  system  of  the  patient  becomes  more 
oppressed,  his  mind  wanders ;  and,  becoming  livid,  he  sinks  into 
a  stupor  from  which  he  can  not  be  aroused,  and  which  in  a  short 
time  terminates  in  death. 

In  the  second  case  there  is  but  little  reaction,  the  pulse  running 
up  to  90  or  100  in  the  adult,  110  to  120  in  the  child,  and  op- 
pressed. There  is  tendency  to  coldness  of  the  extremities,  the 
skin  being  harsh  and  dry,  or  sometimes  moist  and  atonic.  The 
eruption  appears  the  first,  second,  or  third  day,  and  is  a  dusky-red, 
not  readily  eifaced  by  pressure. 

There  is  marked  dullness  and  hebetude  from  the  commencement, 
and  frequently  the  patient  is  almost  entirely  unconscious  a  few 
hours  after  the  appearance  of  the  eruption.  It  runs  a  very  rapid 
course  in  most  instances,  terminating  fatally  by  the  third  to  the 
sixth  day.  The  eruption  becomes  dusky  and  livid,  petechise  ap- 
pear, the  tongue  is  dry  and  brown,  sordes  on  the  teeth,  urine  and 
faeces  very  offensive,  coma  or  low  muttering  delirium,  and  gradu- 
ally increasing  difficulty  of  respiration. 

Diagnosis. — The  diagnosis  is  not  always  easily  made  at  the 
commencement  of  the  disease;  yet  this  is  not  so  important,  be- 
cause the  symptoms  show  it  to  be  a  grave  form  of  disease,  of  a 
congestive  and  malignant  type.  The  extreme  febrile  reaction  in 
the  one  case,  associated  as  it  is  with  dullness  and  hebetude  of  the 
intellectual  functions,  the  dusky  discoloration  of  the  tongue  and 
mucous  membrane  of  the  mouth,  are  characteristic  symptoms. 

In  the  other  case,  the  great  prostration,  feeble  reaction,  dull- 
ness and  tendency  to  coma,  the  appearance  of  the  dusky  erup- 
tion, etc.,  show  the  nature  of  the  disease. 

Prognosis. — The  disease  varies  in  malignancy  and  mortality 
in  different  sections  of  country  and  at  diflferent  times.  So  that 
while  under  one  class  of  circumstances  we  should  regard  the 
prognosis  as  favorable  in  a  large  majority  of  cases,  in  another  it 
would  be  unfavorable. 

Much  will  depend  upon  the  time  when  the  patient  is  seen.  If 
quite  early  in  the  progress  of  the  disease,  very  severe  cases  may 


176  DISEASES  OF  CHILDREN. 

be  conducted  to  a  favorable  termination.  While,  if  the  disease 
is  allowed  to  progress  unchecked  for  a  day  or  two,  or  is  aggra- 
vated by  injudicious  medication,  the  more  mild  cases  will  be 
rendered  unmanageable. 

Treatment. — There  are  three  plans  of  treatment  that  I  think 
may  be  relied  upon,  and  I  will  state  them  plainly,  endeavoring 
to  point  out  the  special  cases  where  a  preference  should  be  given 
to  one  over  another.  Taking  the  majority  of  cases  I  think  I 
should  value  them  in  about  the  order  in  which  they  are  stated, 
relying  upon  the  first  plan  especially  in  very  bad  cases. 

Make  an  infusion  of  Capsicum  one  part,  Bayberry  six  parts, 
having  it  as  strong  as  the  patient  can  take  it  with  comfort.  Then 
give  the  acetous  emetic  tincture  in  doses  of  from  one-fourth  to 
one-half  teaspoonful  every  ten  or  fifteen  minutes,  with  as  much 
of  the  infusion  as  the  child  will  drink.  We  do  not  wish  to  pro- 
duce immediate  vomiting,  but  desire  to  get  the  general  influence 
of  Lobelia  upon  the  system,  so  that  if  it  is  not  well  tolerated  by 
the  stomach,  we  lessen  the  dose,  and  apply  a  stimulant  fomenta- 
tion over  the  epigastrium,  to  aid  its  retention.  Continuing  it  in 
this  way  for  one  hour  or  more,  we  notice  that  the  depression  of  the 
fever  is  being  replaced  by  the  influence  of  the  Lobelia,  and  when 
this  becomes  marked,  we  carry  it  to  free  and  thorough  emesis. 

In  the  meanwhile,  the  child  being  placed  in  bed  between 
blankets,  hot  bricks  wrapped  in  flannel  wrung  out  of  an  infusion' 
of  Capsicum  with  vinegar  and  water,  are  placed  at  the  feet,  by 
each  thigh,  and  by  each  side  of  the  trunk,  at  such  distance  as  to 
be  in  no  danger  of  burning  the  child.  Have  the  blanket  loose 
over  the  body,  but  well-tucked  down  at  the  feet  aird  around  the 
neck,  to  prevent  the  escape  of  the  vapor.  After  a  free  and 
vigorous  circulation  is  established,  the  body  may  be  rubbed  dry 
with  a  flannel,  and  wrapped  in  a  dry  blanket. 

In  the  second  method  of  treatment  we  desire  to  obtain  the 
stimulant  influence  of  Lobelia  or  Ipecacuanha  upon  the  circula- 
tion. I  would  order  them  in  this  form :  I^  Lobelia  Seed 
(powdered),  gr.  xx. ;  Capsicum  5j.  Mix  and  divide  in  eighty 
powders.  These  may  be  administered  as  often  as  every  fifteen 
minutes,  every  half  hour,  or  hour.  Occasionally  they  will  pro- 
duce slight  nausea,  which  is  not  objectionable,  providing  it  does 
not  go  so  far  as  retching  or  the  rejection  of  the  remedy.  Ii)ccacu- 
anha  is  given  in  doses  of  one-fourth  to  one-half  grain  every 
hour,  always  less  than  will  produce  vomiting,  and  is  thus  con- 


SPOTTED   FEVER.  177 

tinned  until  reaction  is  well  established.  I  like  the  action  of  the 
Lobelia  the  best,  though  the  Ipecac  has  been  used  with  considera- 
ble success. 

To  aid  these,  an  enema  of  an  infusion  of  Bayberry,  Lobelia 
and  Capsicum,  may  be  employed  with  good  advantage.  I  am 
satisfied  that  I  have  seen  the  patient  aroused  by  this  means,  so  as 
to  obtain  the  influence  of  other  remedies  by  the  stomach,  when 
without  this,  it  would  have  been  impossible. 

Dry  cupping  to  the  spine,  is  sometimes  of  advantage,  but  in 
the  majority  of  cases,  I  would  prefer  the  stimulant  vapor-bath, 
as  first  named,  and  friction  with  Comp.  Tinct.  of  Capsicum. 

The  third  method  of  treatment  is  based  upon  the  specific  action 
of  Belladonna  to  overcome  congestion  and  stimulate  the  circu- 
lation. This  has  not  been  as  thoroughly  tested  as  we  would  wish, 
yet  some  very  favorable  reports  have  been  made  of  it.  In  Cali- 
fornia, the  Atropia  has  been  employed;  we  have  always  used  the 
the  tincture  of  Belladonna.  For  a  child  two  years  old,  I  should 
order :  1^  Tinct.  of  Belladonna  gtt.  v.  to  x. ;  Tinct.  of  Aconite 
gtt.  V. ;  water  Siv.  Of  this,  give  a  teaspoonful  every  half  hour, 
until  its  influence  in  arousing  the  nervous  system  and  overcom- 
ing the  congestion  is  noticed,  afterward  every  hour,  until  the 
circulation  becomes  free,  and  the  dangerous  symptoms  have 
passed  away. 

In  either  case  I  should  employ  the  sulphite  of  soda,  or  sul- 
phurous acid,  in  the  usual  doses,  as  soon  as  this  first  influence 
was  established,  and  continue  it  until  the  dirty  coat  was  entirely 
gone.  But  if  at  any  time,  the  tongue  becomes  dry  and  dark,  I 
would  substitute  the  dilute  muriatic  acid. 

The  Comp.  Powder  of  Leptandrin  may  be  given  in  from  one 
to  two  grain  doses  four  times  a  day  with  remarkable  efficacy.  It 
acts  mildly,  but  efficiently,  upon  the  glandular  system,  and  re- 
moves morbid  and  worn-out  material  from  the  intestinal  tract, 
leaving  it  free  from  irritation. 

Quinia  may  be  used  by  inunction,  early  in  the  disease,  and  its 
use  in  this  way  continued  to  the  complete  establishment  of  con- 
valescence. I  do  not  think  that  its  internal  administration  in 
the  early  stages  of  this  disease,  has  been  attended  with  any  good 
effect,  but,  on  the  contrary,  has  frequently  increased  the  depres- 
sion of  the  nervous  system. 

Tincture  of  muriate  of  iron  may  be  occasionally  given  alter- 
nately with  the  sulphite  of  soda,  so  as  to  obtain  the  good  influ- 
12 


178  DISEASES  OP  CHILDREN. 

ence  of  both.  In  a  majority  of  cases,  it  will  be  well  to  put  the 
patient  upon  its  use  for  some  days  after  other  remedies  are 
suspended. 

EPIDEMIC  CEREBRO-SPINAL  MENINGITIS. 

Closely  associated  with  spotted  fever,  and  also  with  diphtheria, 
is  the  disease  known  by  the  name  of  epidemic  cerebro-spinal 
meningitis.  These  three  bear  a  very  close  relationship,  in  that 
each  presents  very  similar  lesions  of  the  nervous  system,  both 
during  the  progress  of  the  disease,  and  in  the  sequelae.  In  all 
three  there  is  the  evidence  of  the  action  of  a  blood  poison,  and 
the  breaking  down  of  the  blood,  and  in  each,  death  may  be  the 
result  of  the  lesion  of  the  nervous  system,  or  of  the  lesion  of  the 
blood. 

In  this  country,  within  the  last  ten  years,  the  three  diseases 
have  prevailed  in  an  epidemic  form,  one  succeeding  another,  and 
in  some  cases  seeming  to  merge  into  one  another.  We  had  first 
the  epidemic  diphtheria,  next  the  epidemic  spinal  meningitis,  and 
last  the  spotted  fever. 

Pathology. — The  profession  are  not  agreed  as  to  the  path- 
ology of  epidemic  spinal  meningitis,  though  it  is  now  generally 
regarded  as  bearing  a  very  close  relation  to  typhus  and  typhoid 
fevers,  epidemic  dysentery,  etc.  I  think  there  is  no  doubt  but 
that  it  is  produced  by  an  animal  poison,  which,  gaining  entrance 
to  the  blood,  gives  rise  to  the  phenomena  of  fever,  and  acting 
from  the  blood,  specially  affects  the  cerebro-spinal  centers,  pro- 
ducing the  peculiar  lesions  that  characterize  this  disease. 

What  this  poison  is,  we  are  unable  to  say,  neither  are  we  able 
to  account  for  its  origin  or  propagation,  in  many  cases.  That 
the  disease  is  contagious,  in  its  severer  forms,  I  am  well  satisfied, 
but  this  is  also  true  of  typhoid,  especially  of  typhus,  and,  at 
times,  of  nearly  all  diseases  which  present  that  grouping  of  symp- 
toms cnWed  typhoid.  In  some  instances,  it  has  seemed  as  if  there 
were  an  endemic  influence  causing  the  disease.  In  others,  it  has 
been  distinctly  epidemic.  There  is  yet  much  mystery  in  regard 
to  ej)idemic  influences,  and  until  the  subject  has  been  more  thor- 
oughly studied,  it  will  be  useless  to  theorize  upon  it. 

Symptoms. — The  cases  of  cerebro-spinal  meningitis  may  be 
divided  into  two  classes,   the   distinction  being   very   marked. 


CEREBRO-SPINAL  MENINGITIS.  179 

Occasionally,  we  will  find  it  prevailing  in  both  forms,  at  the 
same  time,  in  a  locality ;  but  more  frequently  it  will  maintain 
the  one  form  in  all  the  cases,  at  one  place,  or  during  one  season. 
We  may  call  these  two  classes  the  rapid  and  the  slow  cerebro- 
sjjinal  meningitis,  as  this  expresses  the  greatest  difference  in  the 
symptoms. 

In  the  first,  or  rapid  form  of  the  disease,  there  is  but  a  short 
period  of  incubation,  rarely  exceeding  a  day.  The  patient  feels 
dull  and  prostrated,  and  if  old  enough  to  complain,  it  is  of  pains 
in  the  back,  head  and  limbs.  The  chill  is  usually  well  marked, 
the  extremities  being  cold,  tRe  surface  shrunken  and  pallid,  and 
occasionally,  severe  rigors.  It  will  be  noticed  that  during  the 
chill  there  is  greater  dullness  of  the  mind  and  prostration  than 
should  attend  an  ordinary  chill,  and  the  patient  seems  to  suffer 
severely. 

In  the  course  of  one  or  two  hours,  the  chill  passes  away  and 
febrile  reaction  succeeds.  The  surface  becomes  flushed,  and  the 
temperature  is  increased.  The  pulse  increases  in  frequency  to 
120  or  140  beats  per  minute.  The  face  is  flushed,  the  eyes  in- 
jected and  suffused,  and  the  head  is  warmer  than  other  portions 
of  the  body.  The  tongue  and  mucous  membrane  of  the  mouth 
are  usually  dusky,  and  the  tongue  coated  with  a  yellowish-white 
pasty  fur. 

During  the  first  few  hours,  sometimes  for  a  day,  the  patient 
complains  of  pain  in  the  back,  and  muscular  pains  in  various 
parts  of  the  body,  and  though  there  is  great  dullness  of  intellect, 
yet  the  patient  is  restless  and  uneasy.  It  will  also  be  noticed 
that  moving  the  child  increases  the  suffering,  sometimes  so  much 
that  we  are  obliged  to  let  it  remain  in  the  one  position. 

By  the  second  day,  the  patient  has  sunk  into  a  stupor,  from 
which  it  is  difficult  to  arouse  it.  The  surface  is  markedly  flushed 
and  dusky ;  the  pulse  very  frequent  and  wiry,  in  the  majority  of 
cases,  but  in  some  it  is  open  but  oppressed.  Respiration  is  diffi- 
cult, and  the  patient  shows  marked  evidences  of  imperfect  aera- 
tion of  the  blood.  The  characteristic  symptom  is  a  fixure  of  the 
spinal  column,  the  head  being  drawn  backward,  or  to  one  side  ; 
or  tlie  disease  may  show  itself  in  the  same  way  in  the  dorsal  or 
lumbar  regions.  Occasionally,  we  notice  evidence  of  partial 
paralysis  this  early  in  the  disease.  At  other  times,  convulsions 
come  on  early,  or  the  disease  is  announced  by  them. 

Thus  it  progresses  rapidly  to  a  fatal  termination,  the  patient 


180  DISEASES  OF    CHILDEEN. 

rarely  lasting  longer  than  four  or  five  days,  if  not  relieved,  and 
sometimes  it  terminates  fatally  within  forty-eight  hours. 

In  the  other  form  of  the  disease,  the  forming  stage  may  last 
from  one  day  to  a  week,  presenting  the  usual  symptoms  of  dull- 
ness and  hebetude,  and  arrested  function.  The  chill  is  not  very 
marked,  though  it  may  last  for  the  greater  part  of  a  day,  or  be 
made  up  of  slight  chills  and  febrile-reactions,  of  short  duration. 

Reaction  comes  up  slowly,  and  is  not  fully  established  before 
the  end  of  the  first  twenty-four  hours.  The  temperature  is 
increased,  the  pulse  increased  in  frequency  and  hardness,  the 
patient  restless  and  fretful,  and  if  old  enough,  complaining  of 
pains  in  the  back,  head,  limbs,  or  not  unfrequently,  simply  of  a 
hurting,  without  being  able  to  locate  it  at  any  one  point.  The 
secretions  are  arrested;  the  skin  becomes  dry  and  harsh,  the 
urine  scanty  and  high  colored,  and  the  bowels  constipated.  The 
tongue  in  some  cases  is  contracted  and  reddened,  with  a  coat 
having  a  shade  of  brown  ;  in  others  it  is  broad,  pallid,  and  cov- 
ered with  a  pasty  white  coat. 

Usually  at  first,  the  face  is  slightly  flushed,  the  eyes  bright, 
the  pupils  contracted,  and  the  mind  active.  The  patient  is  uneasy 
and  restless,  and  does  not  sleep  well.  The  child  maintains  one 
position,  and  the  fixure  of  the  back  is  marked,  and  if  moved,  so 
as  to  bend  the  spinal  column,  it  cries  out  with  pain. 

Thus,  day  after  day,  the  fever  continues,  sometimes  presenting 
the  symptoms  of  a  remittent,  at  others  of  a  continued  fever. 
There  is  a  gradual  increase  in  its  severity,  and  necessarily  an  in- 
creasing debility  of  the  child.  Occasionally  the  fever  will  run 
very  high  about  the  sixth  to  the  tenth  day,  and  there  will  be 
evident  delirium.  Passing  into  the  third  week,  the  symptoms 
assume  a  typhoid  condition,  which  gradually  increases  as  time 
passes.  • 

I  do  not  think  that  at  this  time  there  are  any  distinctive  symp- 
toms, but  the  tenderness  on  pressure  over  the  spine,  and  the  pain 
when  the  child  is  moved,  except,  possibly,  the  greater  excitement 
of  the  nervous  system,  which  in  this  case  replaces  the  dullness 
of  typhoid.  But  sooner  or  later  in  the  disease,  this  excitement 
is  replaced  by  coma,  which  sometimes  becomes  a  marked  feature 
in  fatal  cases. 

A  peculiarity  of  the  disease  is,  that  having  run  the  course  I 
have  described,  for  two,  three  or  four  weeks,  the'symptoms  gradu- 
ally  give   way  to  treatment;   the  fever  is  arrested,   secretion 


SPOTTED  FEVER.  181 

established,  the  child  sleeps  well  at  night,  takes  food  and  seem- 
ingly digests  it,  but  further  than  this  there  is  no  advance  to  re- 
covery. There  is  no  increase  of  the  strength,  indeed,  no  increase 
of  flesh,  and  thus  week  after  week  will  pass  by  without  an  appre- 
ciable change.  After  a  time,  however,  it  will  be  noticed  that 
the  child  is  failing,  arid  in  two  or  three  weeks  it  dies — but  of 
what  it  is  impossible  to  say.  I  have  known  of  many  cases  that 
had  a  duration  of  three  or  four  months,  and  an  exceptional  case 
that  terminated  fatally  at  the  commencement  of  the  eighth  month 
from  the  date  of  attack,  there  being  no  time  during  which  the 
child  was  able  to  sit  up. 

Diagnosis. — In  the  first  form  of  the  disease,  the  symptoms 
are  of  a  very  grave  character  from  the  commencement,  and  we 
are  able  to  trace  their  relationship  to  spotted  fever  and  the  more 
malignant  cases  of  diphtheria.  The  pains  in  the  back  and  head, 
the  severe  muscular  pains,  are  characteristic,  and  even  where  the 
child  is  too  young  to  describe  its  sufferings,  its  appearance  will 
evidence  it.  The  pain,  or  expression  of  suffering,  upon  moving 
the  body,  is  the  evidence  of  spinal  disease. 

In  the  second  class  of  cases,  the  disease  comes  on  insidiously, 
and  there  may  be  but  little,  if  anything,  to  arouse  the  suspicion 
of  the  practitioner  that  he  has  more  than  an  ordinary  fever  to 
treat.  But  after  awhile  his  attention  is  attracted  to  the  pain 
when  the  child  is  moved,  and  the  greater  irritability  of  the  nerv- 
ous system  and  restlessness  than  is  common  in  ordinary  fevers. 

Peogxosis. — I  do  not  regard  the  prognosis  as  unfavorable  if 
the  disease  is  seen  in  time,  and  a  proper  treatment  is  adopted. 
Taking  the  disease  as  it  ordinarily  prevails,  it  is  probable  that 
the  mortality  will  vary  from  ten  to  twenty  per  cent.  We  must 
not  forget  the  fact  that  in  some  situations  the  cause  of  the  disease 
is  very  intense,  and  it  exhibits  very  great  malignancy.  Indeed, 
in  some  localities,  many  times,  death  would  have  commenced  be- 
fore the  physician  was  called  to  the  patient. 

Treatment. — In  the  first  form  of  this  disease,  I  would 
strongly  advise  that  the  treatment  be  commenced  with  a  thorough 
emetic,  of  some  preparation  of  Lobelia.  In  this  case  as  in 
spotted  fever,  we  desire  the  general  influence  of  Lobelia,  as  well 
as  the  act  of  eraesis,  or  in  other  words,  we  want  the  act  of  emesis 
as  the  result  of  its  general  action.    The  acetous  emetic  of  our 


182  DISEASES  OF  CHILDREN. 

dispensatory,  or  the  Corap.  Powder  of  Lobelia  and  Capsicum,  are 
good  preparations  for  this  purpose.  Give  in  five  to  ten  drops  doses 
with  warm  water,  repeated  every  five  or  ten  minutes,  and  when 
the  system  is  brought  fully  under  the  influence  of  the  remedy, 
which  will  be  in  one  or  two  hours,  then  more  freely  until  emesis 
results. 

In  many  cases  it  will  be  necessary  to  follow  emesis  with  a 
cathartic.  This  is  particularly  requisite  in  malarial  localities. 
The  intestinal  tract  is  in  the  same  morbid  condition  as  the 
stomach,  and  must  be  aroused  ere  we  can  hope  for  a  satisfactory 
response  from  our  sedatives  or  other  indicated  remedies,  when 
quick  action  is  desired.  I  like  the  action  of  Rhamnus  P.  best, 
prepared  as  follows  :  ^  Tinct.  Rhamnus  P.  Sj.,  Tinct.  Taraxicum 
5j.,  Simple  Elixir  .5j.  M.,  and  give  from  gtt.  xv.  to  xxx.  every 
two  hours,  until  there  has  been  good  action.  If  slow  action  is 
desired  we  can  use  the  Leptandria  compound  gr.  ij.  every  two 
or  three  hours.  Then  comes  our  sedatives,  Aconite  or  Veratrum, 
whichever  is  indicated ;  Veratrum,  if  the  patient  has  a  full  bound- 
ing pulse,  and  Aconite  if  it  is  small  in  volume  and  easily  com- 
pressed. Of  the  former,  gtt.  x.  to  half  a  glass  of  water;  of  the 
latter,  gtt.  v.  to  water  5iv.  Marked  cerebral  irritation  or  coma 
will  generally  be  present  in  a  major  portion  of  cases,  and  in  the 
irritative  ones,  Rhus  tox.  is  a  prominent  remedy;  given,  a  case 
with  excited  circulation,  frontal  pain,  prominence  and  redness  of 
papillae,  and  tip  of  tongue,  and  we  have  the  true  indications  for 
the  remedy.  In  these  cases,  then,  we  would  think  of  Rhus  and 
give  it  curatively.  We  have  another  class  of  symptoms  that  pre- 
sent great  vascular  excitement,  contracted  tissues  and  pupils,  face 
flushed,  and  extreme  restlessness  ;  here  we  would  substitute  Gelse- 
minum  for  Rhus  and  get  its  specific  action  ;  gtt.  v.  of  the  Rhus 
to  water  5iv.,  and  xv.  of  the  Gelseminum  to  the  same  quantity 
of  water,  will  be  the  right  proportion ;  give  in  teaspoonful  doses 
every  hour.  In  the  opposite  cases  we  have  dullness  and  hebe- 
tude, patient  sleeps  with  eyes  partially  unclosed,  tissues  are 
sodden  and  the  whole  system  is  in  an  atonic  condition.  From 
five  to  ten  drops  of  Belladonna  added  to  half  a  glass  of  water  and 
given  every  half  hour  or  hour,  according  to  the  severity  to  the 
case,  will  remove  the  congestion  and  leave  the  system  in  better 
condition  for  the  action  of  other  remedies. 

If  there  was  large  pulse,  tongue  broad  with  dirty  coat,  sweetish 
taste  in  the  mouth  with  pallor  of  mucous  membranes,  I  should 


SPOTTED  FEVER.  183 

prescribe  sirlphite  of  soda,  grains  two  to  four  every  three  hours ; 
but  with  deep  redness  of  mucous  membranes,  slick  tongue,  and 
typhoid  symptoms,  the  patient  wants  muriatic  acid.  In  such 
cases  I  should  associate  Baptisia  with  the  acid.  In  septic  condi- 
tions they  are  definite  agents  and  as  such  produce  definite  results. 
With  the  system  prepared  for  the  antiperiodic,  we  may  give  it 
either  by  mouth  or  by  inunction.  Where  the  soda  is  indicated  I 
prefer  giving  the  quinine  by  inunction.  In  the  other  cases  I 
should  give  an  acidulated  elixir  of  quinine. 

Where  there  is  a  torpid  circulation  of  the  skin,  I  should  associ- 
ate it  with  a  stimulant,  as  follows  :  I^  Quinia  Sulphas  5jv  Cap- 
sicum gr.  X.  to  5ss.,  Adeps  Sij. ;  mix  thoroughly.  This  may  be 
used  with  brisk  friction  two  or  three  times  daily,  and  if  the  tem- 
perature of  the  extremities  is  lowered,  apply  dry  heat  or  friction 
with  the  hand. 

In  the  second  case,  the  treatment  need  not  be  so  active.  I  am 
not  certain,  however,  but  that  in  many  of  these  cases  we  might 
obtain  much  advantage  from  the  action  of  the  emetic  in  the  first 
two.  or  three  days.  Indeed,  I  am  satisfied  that  in  two  cases  I 
arrested  the  disease  by  this  means. 

But  we  would  think  more  particularly  of  Rhus  and  Macrotys, 
plus  the  required  sedative,  in  these  irritative  cases,  though  even 
the  sedative  is  not  always  necessary,  Rhus  doing  the  work  nicely. 
Indications  for  Gelseminum  will  be  met  with  that  remedy  sub- 
stituted for  Rhus.  If  we  get  an  indication  for  a  certain  remedy  in 
a  large  number  of  cases,  we  then  have  an  epidemic  remedy,  and 
with  the  sedative  is  all  sufficient.  Two  or  three  remedies  rightly 
chosen,  have,  in  some  of  the  severest  types  of  disease  of  this 
character,  always  given  me  good  results. 

The  general  sponge-bath,  sometimes  with  hot  water,  two  or 
three  times  a  day,  will  be  found  an  important  aid.  If  the  bowels 
are  torpid  they  may  be  stimulated  to  action  by  a  gentle  laxative, 
or  by  an  enema.  If  the  secretion  of  urine  is  scanty  and  high 
colored,  some  diuretic  infusion,  as  of  mentha  viridis,  with  small 
portions  of  sweet  spirits  of  nitre,  may  be  given. 

DIPHTHERIA.  ^ 

Diphtheria  was  the  first  of  these  epidemics,  making  its  appear- 
ance in  some  sections  as  early  as  1855.  From  then,  up  to  1864, 
it  prevailed  in  most  parts  of  our  country.     It  was  thought  by 


184  DISEASES  OF  CHILDREN. 

many  to  be  a  new  disease,  though  a  reference  to  authorities  will 
show  that  several  epidemics  of  the  same  have  occurred  before, 
and  that  it  was  well  described,  and  received  its  name  from  French 
observers  in  the  last  century. 

Cause. — The  cause  of  diphtheria  is  undoubtedly  a  specific 
animal  poison,  though  how  generated  or  propagated  we  are  unable 
to  tell.  It  prevails  as  an  endemic  or  epidemic  disease,  and  is 
rarely  if  ever  found  in  isolated  cases.  I  have  no  doubt  that  it 
becomes  contagious,  like  other  similar  diseases,  when  it  occurs  in 
its  most  malignant  form.  There  seems,  sometimes,  to  be  a  very 
close  relationship  between  diphtheria  and  scarlatina,  and  cases 
have  been  recorded  where  an  eruption  attended  it.  In  this,  as  in 
some  other  diseases,  the  anomaly  may  have  been  a  mistake  in 
diagnosis,  rather  than  a  difference  in  the  disease. 

Pathology. — I  have  not  changed  my  opinion  of  the  path- 
ology of  diphtheria,  first  published  in  1861,  and  upon  which  the 
treatment  of  the  majority  of  our  physicians  has  been  based.  I 
quote  it  as  then  written,  desiring  to  keep  it  on  record  as  being 
the  first  announcement  of  a  doctrine  that  is  now  generally  ad- 
mitted as  correct. 

"  I  hold  diphtheria  to  be  a  general  as  well  as  a  local  disease, 
as  is  proven  by  the  languor,  listlessness,  torpor  of  the  nervous 
system,  and  derangement  of  the  excretory  organs,  which,  as  a 
general  rule,  precede  all  local  disease ;  all  being  symptoms  of 
perversion  of  the  blood,  and  almost  invariably  indicating  the 
establishment  of  febrile  reaction.  We  also  find  the  evidence 
of  the  perversion  of  the  blood  in  the  heavily  coated  tongue, 
which  is  always  more  or  less  discolored  at  the  commencement  of 
the  disease,  and  always  in  severe  cases,  exhibiting  the  brown- 
ish tinge,  with  more  or  less  sordes  upon  the  teeth  as  it  pro- 
gresses ;  in  the  diphtheritic  deposit  which  is  markedly  different 
from  the  exudations  from  highly-vitalized  blood ;  in  the  secre- 
tion of  urine  in  severe  cases  being  abundant,  in  all  cases  dis- 
colored, frothy,  more  or  less  clouded  with  a  peculiar,  somewhat 
cadaverous  odor — what  the  ancients  would  have  termed  illy-con- 
cocted ;  in  the  evacuations  from  the  bowels,  obtained  by  cathar- 
tics, which  are  frequently  large,  dark,  and  almost  invariably  fetid  ; 
and  especially  in  the  condition  of  the  blood  itself,  when  the 
disease  has  attained  its  maximum,  which  is  dark,  is  not  changed 


DIPHTHERIA.  185 

by  exposure  to  air,  forms  a  loose  and  easily  broken-down  coagu- 
lum,  or  does  not  coagulate  at  all. 

"  Post-mortem  examination  in  those  eases  that  have  run  a  reg- 
ular course,  i.  e.  that  have  not  been  terminated  by  an  extension 
of  the  disease  to  the  larynx,  shows  us  the  blood  broken  down  to 
a  considerable  extent,  more  or  less  discoloration  of  tissues  from 
extravasation  of  the  coloring  matter,  and  softening  of  the  tissues. 
These  facts,  it  appears  to  me,  prove  conclusively  the  opinion 
given  above." 

There  are  some  cases  in  which  the  disease  seems  almost  wholly 
local,  yet  these  are  mild.  Other  cases  will  present  the  evidences 
of  local  disease  first,  and  it  will  only  be  after  some  days  that  the 
serious  character  of  the  general  lesion  will  be  manifest. 

Syjiptoms. — As  above  named,  the  symptoms  of  the  forming 
stage  are  similar  to  those  of  fevers  and  inflammations  generally. 
For  a  day  or  two,  sometimes  for  a  week,  the  patient  is  listless 
and  languid,  does  not  play  with  the  usual  zest,  is  fretful  at  times, 
does  not  sleep  well,  especially  at  night,  drinks  frequently,  and 
has  a  variable  appetite. 

Following  this  is  a  slight  chill,  lasting  one  or  two  hours ;  not 
unfrequently  it  is  so  light  that  it  is  not  noticed  by  the  parents. 
Following  this,  febrile  reaction  comes  up  slowly,  and  varies 
greatly  in  different  cases.  In  Some  the  fever  is  acute,  and  is  a 
marked  feature  of  the  disease.  In  others  the  symptoms  of  fever 
are  but  slight — an  accelerated  and  soft  pulse,  arrested  secretion 
from  the  skin,  kidneys,  and  bowels,  and  an  increased  temperature 
of  the  body,  as  marked  by  the  thermometer,  though  it  is  not  so 
perceptible  to  the  hand. 

As  the  disease  progresses  the  fever  assumes  an  asthenic  or 
typhoid  character,  and  there  is  evidently  a  serious  lesion  of  the 
blood.  In  a  few  cases  the  fever  is  high  from  the  commencement, 
and  continues  to  present  sthenic  symptoms  during  its  entire 
progress. 

The  patient  complains  or  shows  signs  of  sore  throat  at  the 
commencement  of  the  disease.  There  is  difficulty  and  pain  in 
deglutition,  the  child  swallows  frequently  to  moisten  the  throat, 
and  there  maybe  slight  difficulty  in  breathing.  On  examination 
we  find  the  mucous  membrane  of  the  fauces,  tonsils  and  pharynx 
somewhat  swollen,  sometimes  of  a  vivid  red  color,  at  others 
dusky  or  livid,  and  occasionally  presenting  a  blanched  appear- 


186  DISEASES  OF  CHILDEEN. 

ance.  On  some  of  these  parts  we  will  notice  the  characteristic 
exudation — spots  of  an  ashen-gray  or  white  lymph  upon  the  sur- 
face of  the  mucous  membrane.  They  are  usually  small  at  first, 
not  larger  than  a  grain  of  wheat,  or  at  farthest  a  three-cent  piece. 
They  are  usually  grouped  together,  two  or  three  or  more  at  a 
point,  which  is  more  swollen  or  discolored  than  adjacent  parts. 
There  may  be  but  one  of  these  points  of  exudation,  or  several. 
As  the  disease  progresses  the  swelling  becomes  more  marked,  and 
the  points  of  exudation  more  numerous.  The  patches  likewise 
increase  in  size,  sometimes  coalescing,  so  as  to  uniformly  cover 
quite  a  large  surface. 

For  two  or  three  days,  in  the  majority  of  cases,  the  throat  is  dry, 
sometimes,  indeed,  during  the  entire  progress  of  the  disease. 
Then  secretion  is  established  from  the  mucous  follicles,  and  some 
patches  of  exudation  being  removed,  there  is  a  free  secretion 
from  the  denuded  surface.  The  salivary  glands  also  become  more 
active,  and  the  saliva  is  tenacious,  thick,  and  ropy;  and  alto- 
gether the  secretion  is  large,  and  requires  frequent  efforts  at 
removal.  Occasionally  cases  present  themselves  in  which  this 
seems  to  be  the  most  unpleasant  symptom. 

In  the  later  stages  of  the  disease,  we  may  distinguish  two 
classes  of  cases.  In  the  first  the  dryness  continues,  and  the  parts 
become  stiff  and  immobile,  so  that  after  a  time  deglutition  be- 
comes almost  impossible,  and  respiration  is  rendered  very  difficult 
and  labored.  Extending  upward  to  the  posterior  nares  and  nasal 
cavities,  these  are  closed  by  the  swelling ;  and  descending  to  the 
inferior  portion  of  the  pharynx  and  epiglottis,  these  and  asso- 
ciated parts  are  swollen  and  rendered  incapable  of  motion,  and 
the  child  dies,  partly  from  want  of  food  and  drink,  and  partly 
from  imperfect  aeration  of  the  blood. 

In  the  second  class  of  cases,  secretion  commences  about  the 
second  or  the  third  day.  By  the  fifth  day  it  is  quite  free,  some 
portions  of  the  exudation  are  being  detached,  and  the  exposed 
surface  secretes  pus.  In  very  severe  cases  this  ulceration  pro- 
gresses in  every  direction,  but  is  mostly  superficial.  The  tissues 
seem  to  have  lost  their  vitality,  and  the  muscles  their  power  of 
contraction,  and  they  hang  feeble  and  pendulous  and  infiltrated 
with  serum,  when  the  connective  tissue  is  loose.  Thus  we  have 
paralysis  of  the  throat  in  the  second  as  well  as  in  the  first  case. 

This  also  extends  upward  to  the  nose,  sometimes  presenting 
the  distinctive  characteristics  of  diphtheria  throughout.    In  some 


DIPHTHERIA.  187 

of  these  the  discharge  will  be  profuse,  in  others  it  is  retarded, 
becomes  dried,  and  thoroughly  closes  up  the  passages. 

In  other  cases  the  disease  extends  downward  and  involves  the 
pharynx.  Here  the  cjiild  presents  all  the  symptoms  of  croup — 
the  whistling  respiration,  croupal  cough,  loss  of  voice,  and  gradu- 
ally increasing  difficulty  of  breathing.  The  occurrence  of  the 
laryngeal  complication  is  sudden,  and  it  runs  a  rapid  course. 
Thus,  if  not  relieved  by  remedies,  it  will  usually  terminate  fatally 
within  forty-eight  hours. 

Diagnosis. — Diphtheria  is  readily  diagnosed  by  the  specific 
character  of  the  sore  throat.  AVhere  there  is  the  peculiar  ashen 
exudation  upon  the  free  surface  of  the  mucous  membrane,  there 
is  a  case  of  diphtheria,  no  matter  what  the  other  symptoms  may 
be.  AVhen  there  is  no  such  exudation  the  disease  is  not  diph- 
theria. I  admit  that  in  some  exceptional  cases  the  patches  of 
exudation  may  be  thrown  off  very  early,  and  when  the  patient 
is  first  seen  there  will  be  simply  an  ulcerated  sore  throat,  but  in 
all  there  is  the  exudation  at  some  period. 

Prognosis. — As  is  the  case  with  all  endemic  and  epidemic  dis- 
eases, it  prevails  with  different  degrees  of  severity  in  different 
places  and  at  different  times.  Thus  one  physician  may  meet 
■with  it  in  a  form  so  malignant  and  running  its  course  so  rapidly, 
that  a  majority  of  the  cases  will  prove  fatal.  While  another  will 
see  it  in  a  mild  form,  and  with  but  simple  treatment  a  large  ma- 
jority recover.  Thus  with  some  there  has  been  a  mortality  of 
twenty  to  fifty  per  cent.,  with  others  of  not  more  than  two  or 
three  per  cent.,  both  pursuing  the  same  treatment.  Of  course, 
in  laryngeal  complication  the  prognosis  will  be  more  doubtful. 

Treatment. — Diphtheria  being  a  disease  of  the  blood,  the 
treatment  will  in  all  cases  be  general,  with  the  addition  of  local 
treatment  in  severe  throat  complications.  Should  nausea  prevail, 
with  heavily  coated  tongue,  I  would  preface  the  treatment  with  the 
administration  of  a  thorough  emetic  ;  this  will  arouse  the  system 
and  place  the  stomach  in  condition  to  receive  other  remedies. 

In  my  experience  with  this  disease,  in  the  greater  number  of 
cases  taken  from  the  commencement,  I  find  Phytolacca  to  be  the 
most  frequently  indicated.  It  has  a  specific  influence  upon  the 
blood,  the  glandular  system,  and  the  throat.  We  may  use  it 
with  the  indicated  sedative,  or,  as  I  prefer,  in    alternation    with 


188  DISEASES   OF   CHILDREN. 

Tinct.  Aconite  or  Veratrum  gtt.  v.  to  x.,  water  5iv. — Tinct. 
Phytolacca  gtt.  xx.,  water  Siv. ;  dose,  a  teaspoonful  alternately 
every  hour. 

If  there  is  an  excess  of  saliva,  make  a  solution  of  pptassa 
chlorate  5ss.  to  half  a  glass  of  water,  and  give  the  child  a  tea- 
spoonful  four  times  daily.  If  there  is  fetor  with  ulceration, 
Thymol  may  be  given  both  internally  and  used  with  the  spray.  'S^ 
Thymol  gr.  viii.,  Glycerine,  water,  aa.  5ii.  M. ;  a  teaspoonful  once 
in  three  hours,  and  spray  the  throat  three  or  four  times  a  day. 

With  enlargement  of  the  glands  a  local  application  of  Phyto- 
lacca and  glycerine  will  be  excellent  treatment.  Two  drachma 
of  the  first  to  an  ounce  of  the  last ;  saturate  a  flannel  bandage 
and  apply  to  the  throat,  renewing  two  or  three  times  a  day. 

Dusky  color  of  face  and  mucous  membranes,  with  typhoid 
symptoms,  indicates  Baptisia,  which  may  be  given  in  the  usual 
doses  with  Aconite.  Children  of  scrofulous  habits  will  improve 
nicely  on  Lachesis,  and  Lycopodium  may  be  given  when  there 
is  a  low  grade  of  fever,  with  diminished  secretion  of  urine. 

Cases  may  arise  where,  in  the  latter  stage  of  the  disease,  it  will 
be  necessary  to  use  an  emetic,  but  it  will  be  in  laryngeal  compli- 
cations, and  must  be  used  with  care.  We  may  use  the  acetous 
emetic  tincture  in  small  doses,  just  sufficient  to  produce  nausea 
and  gradual  emesis. 

Following  the  sedatives  and  antiseptics  must  be  the  sustaining 
treatment.  The  temperature  must  be  carefully  noted  at  different 
periods  during  the  day,  and  if  it  decreases,  stimulants  must  be 
administered  frequently,  and  in  small  quantities.  Should  high 
temperature  prevail,  we  want  to  think  of  cooling  remedies  in 
addition  to  our  sedatives.  In  malarial  localities,  with  the  system 
prepared  for  the  antiperiodics,  quinine  should  be  given  early  in 
the  disease.  If  there  is  no  gastric  irritation,  but  an  alkaline 
condition,  the  better  way  will  be  to  give  the  acidulated  elixir. 
With  an  atonic  condition,  or  congestion,  I  prefer  the  olive  oil 
preparation  with  thorough  friction. 

In  the  matter  of  local  applications,  there  are  two  remedies 
that  I  prefer  to  all  others  :  they  are  Phytolacca  and  compound 
StilHngia  Liniment.  As  previously  alluded  to,  the  Phytolacca 
will  be  an  essential  part  of  treatment  in  all  cases  with  enlarged 
glands,  using  it  in  combination  with  glycerine.  Tlie  Stillingia 
liniment  is  a  stimulant  and  an  excellent  counter-irritant,  and 
may  be  used   in  both   throat   and   lung  complications.      Satu- 


DIPHTHERIA.  189 

rate  a  flannel  cloth,  and  apply  three  times  a  day.  It  exerts  a 
marked  control  over  the  croupal  symptoms,  when  applied  over 
the  larynx.     In  mild  cases  we  may  use  the  hot  vinegar  pack. 

If  there  is  stupor  and  tendency  to  coma,  or  pain  in  tiie  throat 
with  difficulty  in  swallowing,  give  Belladonna.  Sepsis  with  deep 
redness  of  mucous  membranes  and  slick  tongue,  wants  muriatic 
acid.  If  the  tongue  has  a  dirty  coating,  with  pungent  breath, 
and  the  excretions  look  as  if  fermented,  the  patient  wants  sul- 
phurous acid.  We  may  use  the  first  as  an  acidulated  drink,  add- 
ing two  or  three  drops  to  half  a  glass  of  water,  and  let  the  child 
drink  at  pleasure.  We  get  a  much  better  action  from  the  acid 
in  this  way  than  we  should  if  syrup  were  added.  Of  the  sulphu- 
rous acid,  5ss.  to  water  .5iv.,  and  given  in  teaspoonful  doses  every 
two  hours,  will  give  marked  benefit.  Occasionally  we  have  a 
case  calling  for  sulphite  of  soda.  We  recognize  it  by  the  pasty- 
white  coat  on  the  tongue,  pallidity  of  mucous  membranes,  and  a 
general  atonic  condition  of  the  whole  system.  The  dose  will  be 
three  grains  every  two  hours. 

Now  come  our  cases  of  unusual  severity  :  the  patient  is  debil- 
itated, and  the  throat  ulcerating  with  a  sickening  fetor.  The 
disease  has  extended  up  into  the  nares,  and  the  lips  are  parched, 
and  may  have  sordes  upon  them.  Treatment  must  be  prompt 
and  decided,  and  we  turn  with  confidence  to  bichromate  and 
permanganate  of  potash.  The  former  we  would  use  more  par- 
ticularly in  those  cases  of  a  croupy  nature,  accompanied  by  diffi- 
cult, wheezy  breathing,  and  great  depression.  From  ten  to  fif- 
teen grains  may  be  dissolved  in  half  a  glass  of  water,  and  given 
in  teaspoonful  doses  every  two  hours,  alternating  with  Veratrum. 
Of  the  latter  salt,  we  will  add  from  five  to  ten  grains  to  four 
ounces  of  water,  and  give  a  teaspoonful  eveiy  two  hours. 

As  adjuvants,  I  would  recommend  gargling,  if  the  child  is  old 
enough,  and  spraying  with  the  atomizer,  or  inhalations.  Water 
medicated  with  chlorate  of  potassium,  salicylic  or  carbolic  acid, 
thymol,  chloride  of  calcium,  with  muriated  tincture  of  iron,  and 
the  vapor  of  hot  vinegar,  may  be  employed  with  success.  Cloths 
must  be  kept  at  hand  to  absorb  all  discharges  from  the  mouth, 
and  burned  immediately  ;  and  the  lips  and  mouth  sponged  with 
a  solution  of  thymol  or  chlorate  of  potash.  The  little  patient 
must  be  kept  as  quiet  as  possible,  and  the  food  will  necessarily  be 
of  the  most  sustaining  character,  as  beef  essence,  milk,  and  cus- 
tards of  sea- moss  farina. 


190  DISEASES  OF  CHILDREN. 

With  this,  as  in  other  similar  diseases,  the  general  bath  and 
the  hot  foot-bath  are  employed.  In  the  majority  of  cases  a  stim- 
ulant bath  will  be  preferable,  as  of  salt  water  with  brisk  friction, 
or  the  addition  of  capsicum  or  mustard  to  the  water.  The  hot 
mustard  foot-bath  is  a  very  valuable  means,  and  may  be  used  two 
or  three  times  daily,  and  for  half  an  hour  at  a  time.  It  is  espe- 
cially important  in  severe  cases,  indeed  in  any  case,  that  the  ex- 
tremities be  kept  warm.  I  have  often  thought  that  in  some  it 
was  just  the  difference  between  death  and  recovery.  Let  the 
feet  and  legs  be  cold  for  six  hours,  in  a  severe  case,  and  the 
throat  disease  will  have  advanced  beyond  the  reach  of  medicine. 
In  the  application  of  stimulants  I  prefer  Capsicum,  and  the  use 
of  dry  heat  will  be  the  best  means.  It  is  a  very  good  plan  to 
say  to  the  nurse,  "  If  complaint  is  made  of  any  part,  sponge  it 
with  hot  water,  and  cover  at  once  with  hot  dry  flannel." 

Where  the  larynx  becomes  involved,  and  the  symptoms  of 
croup  developed,  the  treatment  must  be  prompt  and  thorough,  if 
we  expect  to  save  life.  To  give  temporary  relief,  I  direct  the 
inhalation  of  vinegar  and  water  sufficiently  often  to  give  ease, 
using  at  the  same  time  hot  fomentations  assidulously  applied  to 
the  throat.  When  the  case  does  not  seem  to  be  progressing  rap- 
idly, I  place  the  patient  upon  the  use  of  Aconite  and  Phytolacca 
alone,  using  the  Stillingia  liniment  as  a  local  application  over 
the  larynx.  If,  however,  it  is  progressing  rapidly  we  may  give 
the  patient  small  doses  of  acetous  tincture  of  Lobelia  and  San- 
guinaria,  so  as  to  keep  up  continuous  slight  nausea ;  and  when 
the  patient  is  brought  fully  under  the  influence  of  the  remedies, 
it  is  carried  to  free  emesis.  So  far  as  my  experience  goes,  how- 
ever, we  have  much  better  results  if  we  follow  the  direct  indica- 
tions, and  give  the  small  doses. 

ERUPTIVE   FEVERS. 

The  eruptive  fevers  are  caused  by  a  specific  contagion  gene- 
rated during  the  progress  of  the  disease,  and  propagated  by  con- 
tact, by  inhaling  the  gaseous  exhalations,  or  by  the  absorption  of 
the  poison  from  the  clothing  or  the  excretions.  The  poison  is 
capable  of  being  disseminated  by  the  atmosphere  to  a  limited 
extent  in  ordinary  cases ;  but  when  severe,  and  in  numerous 
cases,  it  sometimes  affects  the  atmosphere  for  considerable  dis- 


ERUPTIVE  FEVEE8.  191 

tances,  especially  in  the  direction  of  the  prevailing  winds ;  in 
these  cases  the  disease  assumes  an  epidemic  character. 

In  the  most  of  these  diseases  the  virus  may  be  transmitted  by 
inoculation.  Indeed,  in  any  way  by  which  it  is  brought  in  con- 
tact with  the  body,  so  that  it  may  be  absorbed  into  the  blood,  the 
disease  may  be  disseminated. 

The  causes  of  these  diseases  vary  in  intensity  in  different  sea- 
sons, and  in  different  localities,  so  that  at  one  time  they  will  be 
remarkably  mild,  and  at  another  time  very  severe,  even  malig- 
nant. It  is  pretty  evident  that  the  condition  of  the  atmosphere, 
as  regards  heat  and  cold,  moisture  or  dryness,  and  especially  its 
electrical  condition,  has  much  to  do  with  the  intensity  of  these, 
as  well  as  other  diseases. 

It  has  been  noticed  that  the  eruptive  fevers,  as  well  as  some 
other  diseases,  prevail  in  cycles,  the  periods  being  usually  about 
seven  years.  This  has  been  accounted  for  in  the  case  of  the  class 
under  consideration,  by  the  fact  that  all  the  material  for  such 
disease  is  used  up  in  its  progress  of  two  or  three  years,  and  its 
reappearance  depends  upon  the  presence  of  a  new  population  not 
protected  from  it. 

A  peculiar  feature  of  these  diseases  is,  the  immunity  from  them 
produced  by  one  attack.  It  seems  that  in  each  of  these  cases, 
the  cause  of  the  disease  destroys  all  the  material  capable  of  being 
influenced,  or  all  susceptibility  to  the  influence  in  the  first  attack. 
As  a  general  rule,  the  immunity  from  the  influence  of  the  cause 
a  second  time,  is  perfect  after  the  first  attack,  and  the  person  may 
be  exposed  without  the  least  danger.  There  are  some  rare  cases, 
however,  in  which  the  -person  is  not  thus  protected,  and  in  which 
it  may  recur  one  or  more  times. 

These  fevers  differ  from  all  others,  therefore,  that  an  attack 
protects  the  individual  from  ever  having  the  disease  again,  even 
though  being  exposed  to  the  same  cause.  They  differ  also  in  the 
specific  character  of  the  eruption,  which  is  a  part  of  the  fever. 

Liebig  thus  accounts  for  the  disease  and  its  protective  influ- 
ence :  "  When  a  quantity,  however  small,  of  contagious  matter, 
that  is,  of  the  exciting  body,  is  introduced  into  the  blood  of  a 
healthy  individual,  it  will  be  again  generated  in  the  blood,  just 
as  yeast  is  generated  from  wort.  The  condition  of  transforma- 
tion will  be  communicated  to  a  constituent  of  the  blood  ;  and  in 
consequence  of  the  transformation  suffered  by  this  substance,  a 
body  identical  with,  or    similar   to   the  exciting  or  contagious 


W2  DISEASES   OF  CHILDEEN. 

matter,  will  be  produced  by  another  constituent  substance  of  the 
blood.  The  quantity  of  the  exciting  body  newly-produced  must 
constantly  augment,  if  its  further  transformation  or  decomposi- 
tion proceeds  more  slowly  than  that  of  the  comjiound  in  the 
blood,  the  decomposition  of  which  it  effects.  *  *  *  Jn  the 
abstract  chemical  sense,  reproduction  of  a  contagion  depends 
upon  the  presence  of  two  substances,  one  of  which  becomes  com- 
pletely decomposed,  but  communicates  its  own  state  of  transfor- 
mation to  the  second.  The  second  substance  thus  thrown  into  a 
state  of  decomposition  is  the  newly  formed  contagion.  *  * 
When  the  constituent  removed  from  the  blood  is  a  product  of  an 
unnatural  manner  of  living,  or  when  its  formation  takes  place 
only  at  a  certain  age,  the  susceptibility  of  contagion  ceases  on  its 
disappearance.  The  effects  of  vaccine  matter  indicate  that  an 
accidental  constitution  o  f  the  blood  is  destroyed  by  a  peculiar 
process  of  decomposition,  which  does  not  affect  the  other  con- 
stituents of  the  circulating  fluid." 

As  in  the  case  of  sthenic  fevers,  the  cause,  in  these  diseases, 
seems  to  influence  the  blood  almost  in  direct  ratio  to  the  func- 
tional disturbance.  Thus,  with  an  active  fever,  and  arrested  secre- 
tion, the  poison  seems  to  be  generated  in  increased  quantity. 

In  some  cases  the  influence  of  the  contagion  does  not  cease 
with  the  formation  of  the  specific  virus,  but  originates  a  septic 
decomposition  of  the  blood,  giving  rise  to  putro-adynamic  symp- 
toms, which  frequently  result  in  death,  sometimes  even  before  the 
appearance  of  the  characteristic  eruption. 

VARIOLA-SMALL-POX. 

Small-pox,  like  other  of  the  eruptive  fevers,  is  caused  by  a 
specific  contagion,  generated  during  the  progress  of  the  disease 
in  the  human  body.  This  contagious  matter  may  be  propagated 
by  contact  with  the  person  or  with  articles  of  clothing,  or  indeed 
anything  that  has  been  in  contact  with  him,  and  by  inhaling  an 
atmosphere  impregnated  with  the  poison.  This  atmospheric 
cause  varies  in  different  cases;  in  some  extending  but  a  short 
distance  from  the  person,  frequently  confined  to  the  room ;  in 
other  seasons  extending  considerable  distances  in  the  direction 
of  the  prevailing  winds. 

The  disease  is,  so  far  as  we  know,  always  produced  by  the  one 
cause,  the  specific  virus  of  small-pox,  and  is  never   generated 


VARIOLA.  193 

anew  or  without  this.  While  it  is  thus  contagious,  it  also  be- 
comes endemic  and  epidemic  by  peculiar  states  of  the  atmosphere. 
It  also  prevails  in  cycles,  as  heretofore  stated,  some  of  these  being 
mild,  others  severe.  More  commonly,  perhaps,  we  have  one  or 
two  years  in  each  cycle,  in  which  the  disease  is  severe,  then 
others  of  a  milder  type. 

The  virus  of  small-pox  acts  upon  the  blood,  giving  rise  to  such 
changes  in  this  fluid  as  produce  all  the  phenomena  noticed, 
and  generating  within  it  a  virus  similar  to  itself.  Finally,  this  is 
thrown  upon  the  surface  in  the  form  of  pustules,  and  the  blood 
being  freed  from  it  convalescence  ensues.  \Ye  may,  in  this  dis- 
ease, study  the  pathology  of  all  fevers,  as  this  presents  all  the 
phenomena  of  a  fever,  with  a  cause  tangible  to  our  senses.  We 
may  trace  the  incubation  of  the  virus  in  the  body,  as  it  gradually 
increases  and  influences  all  the  functions  of  life.  The  gradually 
increasing  prostration  terminating  in  a  chill;  the  febrile  reaction 
following  this,  the  eruption  of  the  small-pox  pustules,  and  finally 
the  subsidence  of  the  disease  when  the  virus  is  thus  wholly 
removed. 

Symptoms. — Small-pox  is  divided  into  two  classes,  the  discrete 
and  confluent,  though  these  are  differences  in  its  severity,  not  in 
its  character.  In  discrete  small-pox  the  pustules  are  not  so  nu- 
merous but  that  they  have  room  for  full  development  upon  the 
skin.  In  confluent  small-pox  the  points  of  eruption  are  so 
numerous,  that  as  they  are  developed  into  pustules  they  crowd 
upon  each  other  and  run  together,  so  that  on  large  portions  of 
the  surface  nothing  is  seen  but  the  eruption,  and,  as  it  matures, 
the  formation  of  a  single  crust. 

In  the  discrete  form  the  premonitory  symptoms  are  not  severe. 
The  child  will  be  fretful,  restless  in  its  sleep,  and,  if  old  enough, 
will  complain  of  feeling  tired.  The  chill  is  tolerably  well 
marked,  though  not  severe,  and  lasts  from  one  to  two  hours. 
The  febrile  reaction  comes  up  pretty  actively,  though  it  bears  a 
closer  resemblance  to  febricula  than  to  the  severer  fevers.  The 
eruption  generally  makes  its  appearance  during  the  latter  part  of 
the  second  and  during  the  third  day,  and  at  this  time  the  fever 
has  attained  its  highest  point.  By  the  fourth  day  the  fever  will 
have  subsided,  to  a  considerable  extent,  and  from  this  to  the 
tenth  or  twelfth  day,  is  so  slight  as  to  give  but  little  annoyance. 
At  this  time,  when  maturation  is  complete,  a  secondarv  fovcr  is 
develoi)ed,  which,  for  a  few  hours,  is  pretty  active.  This  passing 
13 


194  DISEASES  OF    CHILDREN. 

off,  secretion  is  established,  the  appetite  and  digestion  are  restored, 
and  the  child  convalesces  rapidly. 

In  the  confluent  form  the  premonitory  symptoms  are  noticed 
earlier.  The  child  appears  depressed,  its  appetite  is  poor,  it  is 
restless  and  fretful  during  the  day,  and  does  not  sleep  soundly  at 
night.  As  we  approach  the  period  of  chill  these  symptoms  are 
more  marked,  and  the  child  presents  evident  symptoms  of  suffer- 
ing. The  chill,  in  this  case,  is  usually  well  marked  and  pro- 
tracted, the  temperature  is  really  lowered,  the  pulse  increased  in 
frequency,  the  skin  contracted,  presenting  the  cutis  anserina,  and 
in  many  cases  there  are  marked  rigors. 

The  febrile  reaction  comes  up  rapidly  in  most  cases,  and  runs 
high.  The  surface  is  hot  and  dry,  the  pulse  frequent,  full  and 
hard,  the  urine  scanty,  the  bowels  constipated,  the  mouth  dry, 
the  tongue  coated  with  a  white  fur,  the  face  flushed,  the  eyes 
bright,  with  great  restlessness  and  irritability.  The  child  expresses 
evidences  of  suffering  that  can  not  be  mistaken,  and  we  suppose 
it  has  all  the  aches  and  pains  that  are  pathognomonic  of  small- 
pox in  the  adult. 

The  fever  continues  on  without  abatement,  rather  increasing 
than  otherwise,  until  the  eruption  makes  its  appearance.  The 
symptoms  of  suffering  pass  away  after  the  first  day,  and  there  is 
usually  not  so  much  restlessness,  though  occasionally  the  irrita- 
tion of  the  nervous  system  continues  to  be  a  marked  feature,  and 
there  may  be  convulsions  and  occasionally  evident  delirium. 

About  the  time  the  eruption  is  making  its  appearance  the 
throat  seems  to  be  stuffed  up,  and  there  is  free  secretion  from  it 
and  the  mouth.  In  some  cases  this  becomes  quite  severe,  the 
thi'oat  is  swollen,  and  the  secretion  profuse  and  tenacious,  which 
render  deglutition  and  even  respiration  difficult. 

The  eruption  appears  on  the  third  day,  at  first  on  the  face,  then 
the  trunk,  and  finally  the  extremities,  usually  not  being  fully 
out  before  the  end  of  the  fourth  or  the  fifth  day.  In  most  cases 
there  is  a  slight  abatement  of  the  fever  after  the  eruption  has 
made  its  appearance,  presenting  frequently  a  morning  remission 
and  evening  exacerbation.  It  varies  greatly  in  intensity  in  differ- 
ent cases.  In  some  it  is  very  active  in  all  its  symptoms,  and 
children  are  frequently  delirious.  In  others  it  presents  the  usual 
symptoms  of  an  infantile  remittent.  In  the  more  malignant 
cases  it  is  asthenic  in  character,  and  the  symptoms  are  of  a 
typhoid  type. 


VARIOLA.  195 

About  the  twelfth  day  from  the  chill,  or  ninth  from  the  erup- 
tion, a  secondary  fever  makes  its  appearance,  and  lasts  from  one 
to  three  days.  Usually  it  is  very  active,  and  the  child  suffers 
more  from  the  fever  than  at  any  time  during  the  progress  of  the 
disease.  Maturation  being  complete,  when  this  fever  declines, 
the  secretions  are  re- established,  and  the  child  slowly  convalesces. 

Having  described  the  general  symptoms  of  the  disease,  we 
must  now  study  the  eruption.  When  it  first  appears  it  simply 
presents  a  small  red  spot,  resembling  somewhat  a  flea  or  mosquito 
bite.  These  look  as  if  slightly  elevated,  and  when  we  place  a 
finger  upon  one  it  feels  hard,  as  if  a  small  shot  were  imbedded  in 
the  skin.  On  the  second  day  the  redness  has  increased  in  size, 
the  elevation  is  more  perceptible  to  the  eye,  and  a  minute  point 
is  seen  in  the  center  from  which  the  future  pustule  is  to  be  de- 
veloped. On  the  third  day  the  red  spot  has  increased  in  size 
still  more,  and  in  its  center  is  seen  a  small  vesicle,  distinctly 
rounded  in  form,  and  fi.lled  with  a  clear,  limpid  serum.  On  the 
fourth  day  this  has  increased  in  size,  is  flattened,  seems  to  be  tied 
down  in  its  center — umbilicated — and  the  lymph  is  becoming 
yellowish  and  opaque.  On  the  fifth  day  it  has  attained  about 
one-half  its  size,  is  yellowish  and  opaque,  distinctly  umbilicated, 
and  stands  on  a  swollen  base,  and  presents  a  red  areola. 

Continuing  to  increase  in  size  it  attains  its  maturity  by  the 
ninth  day,  when  it  is  three-eighths  to  one-half  inch  in  diameter, 
the  red  areola  being  about  as  much  larger ;  it  is  yellowish  and 
opaque,  and  distinctly  umbilicated.  The  tumefaction  of  the 
base,  when  the  points  of  eruption  are  numerous,  is  such  as  to 
give  a  uniform  swelling  of  the  surface.  Thus,  in  the  severer 
cases,  the  eyes  are  closed,  and  the  features  so  effaced  that  the 
person  could  not  be  recognized. 

When  maturation  is  thus  completed,  some  of  the  pustules 
burst  and  discharge  a  portion  of  their  contents.  In  all  it  desic- 
cates, and  forms  a  crust  or  scab,  which  is  retained  in  contact 
with  the  skin  by  the  epithelial  investment  of  the  pustule.  In 
from  three  to  nine  days  this  gives  way  and  the  scabs  are  thrown 
off.  The  parts,  where  they  are  developed,  present  a  bluish  or 
livid  appearance,  which  slowly  passes  away  in  some  five  or  six 
weeks,  though  it  can  be  noticed  for  as  many  months  when  the 
person  is  exposed  to  the  cold. 

In  some  cases  a  process  of  ulceration  is  set  up  at  the  base  of 
the  pustule,  and  the  true  skin  is  destroyed,  to  a  greater  or  less 


196  DISEASES  OF  CHILDREN. 

extent.     This  causes  those  depressions  that  we  call  piithig,  and 
which  are  never  effaced. 

Small-pox  may  be  complicated  with  inflammation  of  any  organ 
or  part.  These  are  not  very  common,  and  are  usually  recognized 
with  ease.  There  are  some  irregularities  in  its  progress,  however 
that  should  be  studied  with  care.  In  one,  the  disease  having 
progressed  to  the  fourth  day,  we  find  the  skin  swollen,  and  as- 
suming a  dusky  appearance ;  yet  the  eruption  does  not  come  out, 
or  appears  sparsely.  At  the  same  time  we  find  the  child  becom- 
ing comatose,  and  also  that  this  is  influencing  every  function 
of  life,  until  finally  death  results.  In  a  second,  the  eruption 
having  made  its  appearance,  recedes;  the  skin  is  swollen  and 
dusky,  and  coma  comes  on,  as  in  the  preceding  case. 

In  malignant  small- pox — that  in  olden  times  received  the 
name  of  black  small-pox — the  skin  seems  swollen  and  dusky  from 
the  commencement.  When  the  eruption  makes  its  appearance  it 
also  is  discolored,  and  the  pustules,  instead  of  being  yellowish, 
have  a  shade  of  brown  or  black,  or  in  some  cases  are  black.  This 
is  associated  with  the  brown  tongue,  sordes  on  the  teeth,  frequent 
small  pulse,  and  other  typhoid  symptoms. 

Diagnosis. — The  diagnosis  of  small-pox  is  not  difficult.  The 
symptoms  preceding  the  chill  for  some  two  or  three  days, — this 
being  marked,  and  followed  by  high  febrile  reaction,  in  which 
the  child  evidently  suffers  much  pain, — are  sufficient  to  arouse 
our  suspicions.  The  eruption  of  red  points,  hard  under  the  finger, 
is  the  diagnostic  evidence  at  this  time.  Afterward  theumbilicated 
pustule  and  its  regular  and  slow  development,  distinguish  this 
from  all  other  eruptions. 

Prognosis. — I  regard  the  prognosis  of  small-pox  as  favorable, 
except  in  those  exceptional  cases  last  described.  Of  course,  some 
children  will  succumb  to  even  its  milder  form,  because  they  have 
not  vitality  to  live  through  any  disease.  The  mortality  attend- 
ing small-pox  seems  to  have  lessened  in  the  ratio  that  the  people 
are  protected  by  vaccination,  thus  proving  that  the  virus  gains 
intensity  as  developed  from  a  large  number  of  persons  at  the 
same  time. 

Treatment. — It  is  contended  by  the  majority  of  writers  that 
small- pox  is  a  self-determined  disease,  and  has  a  regular  course 
to  run,  and  that  this  can  not  be  modified  or  shortened.     In  this 


VAEIOLA.  197 

respect  it  is  said  to  resemble  typhoid  and  other  continued  fevers. 
I  admit  the  resemblance,  and  contend  that  its  course  can  be  both 
modified  and  shortened,  as  we  have  proven  to  be  the  case  with 
continued  fever. 

We  have  the  evidence  of  this  in  the  history  of  inoculation. 
Here  the  small-pox  virus  was  introduced  into  a  system  not  pro- 
tected, but  by  a  system  of  diet  and  means  to  promote  the  secre- 
tions, it  was  caused  to  run  a  very  mild  and  also  a  short  career. 

If  the  small-pox  virus  is  generated  within  the  blood,  and  this 
is  the  cause  of  the  distuvbance  we  witness,  that  disturbance  will 
be  less,  just  in  proportion  as  this  is  developed  slowly  and  re- 
moved by  the  excretory  organs.  There  is  no  doubt  but  that  the 
virus  of  small-pox  may  be  removed  by  the  excretory  organs  in 
very  considerable  quantity.  We  have  already  seen  that  the 
development  or  activity  of  such  blood  poison  was  in  the  ratio  of 
the  frequency  of  the  circulation  and  other  functional  derange- 
ment. If,  therefore,  we  control  the  circulation,  and  establish 
function,  we  will  lessen  the  rapidity  with  which  the  virus  is 
generated,  and  arrest  the  septic  decomposition  that  accompanies 
it;  and  if,  at  the  same  time,  we  stimulate  excretion  by  the  skin, 
kidneys,  and  bowels,  we  will  remove  considerable  portions  of  it, 
and  thus  lessen  the  eruption  upon  the  skin. 

It  will  be  observed  that  the  theory  is  good,  and  is  based  upon 
facts  constantly  witnessed  in  other  diseases.  Experience,  also, 
which  is  the  test  for  every  new  doctrine,  confirms  these  views. 
The  treatment,  then,  will  be  the  same  as  for  arty  other  form  of  fever. 

We  put  the  patient  upon  the  use  of  Aconite  or  Veratrum,  in 
the  usual  doses,  aiding  their  action  by  the  general  sponge-bath 
and  the  use  of  the  hot  foot-bath.  If  there  is  much  irritation  of 
the  nervous  centers,  with  determination  of  blood,  we  add  Gelse- 
minum ;  but  if  the  patient  is  dull  and  torpid,  and  inclined  to 
coma.  Belladonna  is  used  instead. 

The  most  pronounced  symptom  in  the  first  stage  of  small-pox 
is  the  seve7'e  pain,  and  this  suggests  remedies  that  relieve  pain. 
Macrotys  has  been  employed  for  a  half  century  in  these  cases, 
and  so  marked  is  its  action  that  many  have  called  it  a  specific  in 
small-pox.  Bryonia  will  be  found  an  excellent  remedy  when 
the  patient  complains  of  pains  in  the  chest,  with  severe  cough, 
or  uneasiness  in  the  bowels  with  tenderness,  or  pain  in  the  articu- 
lations. Rhus  is  an  admirable  remedy  in  some  cases,  and  will 
be  indicated  by  burning  pain,   by  pain  in  the  forehead,  and  also 


198  DISEASES   OF  CHILDREN. 

by  pain  in  the  neck  and  occiput,  the  tissues  being  very  sore  and 
painful  when  pressed.  Among  the  remedies  to  bring  the  erup- 
tion to  the  surface,  when  it  is  tardy,  there  are  none  better  than 
Belladonna  when  the  patient  is  dull  and  inclined  to  sleep,  and 
Rhus  where  it  is  restless,  uneasy  and  wakeful. 

By  the  second  or  third  day  of  the  treatment  we  may  add  a 
portion  of  the  tincture  of  Asclepias  to  the  sedative  mixture,  and 
commence  the  administration  of  a  solution  of  Acetate  of  Potash 
Sss.,  to  water  5iv. ;  a  teaspoonful  every  three  hours.  This  is 
used  when  the  fever  is  active  and  the  disease  sthenic  in  character. 

The  bowels  are  kept  in  a  soluble  condition  by  the  use  of  laxa- 
tives, but  cathartic  medicines  of  an  irritant  character  are  very 
objectionable.  Citrate  or  carbonate  of  magnesia,  manna,  phos- 
phate of  soda,  or  castor  oil,  may  be  used,  or  in  place  of  them  we 
may  depend  upon  enemata. 

In  some  cases  we  find  the  tongue  broad  and  much  furred,  the 
breath  bad,  and  the  stomach  in  such  condition  that  it  can  neither 
digest  food  nor  receive  remedies  kindly.  Generally  this  may  be 
regarded  as  an  unfavorable  commencement  of  small-pox,  and 
demands  prompt  treatment.  When  marked,  I  would  strongly 
advise  the  use  of  an  emetic,  so  given  as  to  obtain  a  thorough 
action,  then  continuing  the  treatment  as  above  named. 

Where  this  condition  is  not  so  marked,  the  sulphite  of  soda 
may  be  employed,  in  doses  of  five  grains  every  two  hours  until 
removed.  Even  when  an  emetic  has  been  used,  it  will  be  well, 
in  some  cases,  to  follow  it  with  the  sulphites. 

In  the  case  named,  where  the  eruption  is  tardy  in  its  appear- 
ance, we  may  use  the  hot-pack  or  the  emetic,  or  both.  In  giving 
a  hot-pack,  in  this  case,  I  have  an  ounce  of  mustard  added  to  a 
couple  of  gallons  of  water,  and  when  hot  wring  a  blanket  out  of 
it  quickly  and  envelop  the  child,  covering  warmly  with  dry 
blankets  or  comforts.  In  the  majority  of  cases  it  will  be  more 
convenient  to  use  the  stimulant  vapor  by  means  of  hot  bricks,  as 
heretofore  named.  The  emetic  of  Lobelia  is  the  most  powerful 
means  we  have,  if  properly  used.  It  is  given  so  as  to  produce 
its  general  influence,  and  then  carried  to  thorough  emesis,  as  was 
named  in  congestive  and  spotted  fever. 

So  also  in  those  cases  in  which  there  is  a  retrocession  of  the 
eruption.  The  emetic  arouses  the  nervous  system,  throws  off  the 
cause,  and  re-establishes  a  free  and  equal  circulation  of  blood. 
It  may  be  used  alone,  or  associated  with  the  hot  stimulant  bath. 


VARIOLA.  199 

If  the  disease  shows  evidence  of  a  septic  condition  of  the  blood, 
110  class  of  remedies  will  give  better  results  than  the  sulphites. 
The  sulphite  of  soda  is  probably  the  best,  and  may  be  used  freely, 
the  indication  being  a  broad  pallid  tongue,  coated  with  a  dirty 
white  fur.  If  the  tongue  is  red,  moist,  and  covered  with  a  glu- 
tinous nastiness  like  fecal  matter,  sulphurous  acid  will  be  the 
remedy,  giving  it  in  teaspoonful  doses  every  three  hours.  Sul- 
phur may  also  be  burned  in  the  room  to  purify  the  air,  and  the 
bed  utensils  may  be  disinfected  in  the  same  way,  or  by  the  use 
of  chlorinated  soda. 

In  some  cases,  and  these  very  severe  ones,  Baptisia  will  be 
indicated -from  the  commencement.  The  full  leaden  or  purplish 
face,  like  one  who  has  been  exposed  to  severe  cold,  is  the  best 
indication  for  the  remedy.  Sometimes  the  patient  shows  this 
fullness  and  unpleasant  color  over  the  entire  surface,  and  even 
the  mucous  membranes  will  bear  the  tint.  Baptisia  is  added  to 
the  sedative  mixture  in  the  proportion  of  gtt.  x.  to  gtt.  xv.  to 
water  5iv.  It  is  an  admirable  remedy,  and  I  should  hardly 
know  how  to  treat  these  unpleasant  cases  without  it. 

Occasionally  muriatic  acid,  or  a  good  sharp  cider,  or  whey, 
will  serve  a  good  purpose ;  the  last  making  a  very  good  diet 
drink  in  these  cases. 

Chlorate  of  potash  will  sometimes  be  indicated  in  small-pox, 
but  in  this,  as  in  other  cases,  we  follow  our  nose — the  bad  odor 
being  the  indication. 

To  relieve  the  unpleasant  condition  of  the  throat  during  the 
first  days  of  the  eruption,  we  order  a  gargle  of  sulphite  of  soda, 
chlorate  of  potash,  or  Baptisia,  when  the  child  is  old  enough  to 
use  remedies  in  this  way.  With  younger  children  these  remedies 
may  be  used  with  a  spray  apparatus,  or  by  inhaling  the  vapor 
from  them  when  heated.  Usually,  Avhen  no  apparatus  is  at  hand 
for  using  inhalations,  we  will  find  the  vapor  of  vinegar  and  water 
to  answer  a  good  purpose. 

To  prevent  pitting  I  depend  wholly  upon  cleanliness,  keeping 
the  room  darkened  to  obviate  the  irritant  action  of  light.  Using 
glycerine  soap,  I  have  the  exposed  parts  washed  with  a  soft 
sponge  several  times  a  day,  so  as  to  keep  them  clean  and  soft. 
Occasionally  a  soft  and  thin  cloth,  wet  with  equal  parts  of  glyce- 
rine and  water,  may  be  used  when  parts  show  considerable  irri- 
tation. With  quite  a  large  experience  in  the  treatment  of  the 
disease,  the  results  of  this  method  have  been  very  satisfactory. 


200  DISEASES   OF   CHILDREN. 

The  sedatives  are  continued  during  the  whole  progress  of  the 
disease,  so  as  to  control  febrile  reaction  ;  and  generally  where 
the  treatment  as  given  is  pursued,  there  will  be  but  slight  secon- 
dary fever.  When  this  comes  up,  however,  it  is  controlled  by 
increasing  the  frequency  of  the  dose. 

Throughout  the  progress  of  the  disease,  which  is  exhausting 
in  its  character,  especial  pains  should  be  taken  to  prevent  irri- 
tation of  the  digestive  organs,  and  to  support  the  strength  by 
appropriate  food.  When  the  child  is  nursing  the  mother's  milk 
is  sufficient,  and  is  the  best  food.  At  a  more  advanced  age, 
boiled  milk,  slightly  salted,  taken  hot,  will  be  more  kindly  re- 
ceived and  better  digested  than  most  other  food. 

In  some  cases  it  will  be  necessary  to  support  the  strength  of 
the  patient  by  the  use  of  the  bitter  tonics  and  iron.  Quinine 
with  Hydrastine,  in  doses  of  one-half  grain,  is  generally  our  best 
prescription.  This  may  be  aided  by  the  muriated  tincture  of 
iron  with  glycerine,  as  heretofore  named.  When  the  mucous 
membranes  present  a  dark-red  or  dusky  appearance,  the  dilute 
muriatic  acid  will  answer  the  best  purpose. 

VARIOLOID. 

Varioloid  is  small-pox  modified  by  the  vaccine  disease.  In 
some  persons  the  cow-pox  is  but  partially  protective,  or  it  may 
be  wholly  protective  at  first,  but  as  time  passes,  the  susceptibility 
to  the  virus  of  small-pox  is  gradually  reproduced.  U])on  Lie- 
big's  theory,  the  material  in  the  blood,  upon  which  the  small-pox 
poison  acts,  is  reproduced  in  smaller  quantity. 

Varioloid  is  small-pox  in  every  sense.  It  is  produced  by  the 
specific  contagion  of  small-pox,  and  in  turn  it  generates  a  virus 
which  will  give  rise  to  the  fully  developed  disease  in  a  person 
not  protected  by  vaccination.  It  differs  only  in  that  the  symp- 
toms are  milder,  and  it  runs  a  shorter  course.  The  symptoms 
are  usually  those  of  the  discrete  form  of  small-pox.  The  fel)rile 
action  subsides  with  the  appearance  of  the  eruption,  or  in  the 
severer  cases  is  remittent  in  character,  and  not  severe.  The  pe- 
riod of  maturation  is  generally  but  seven  days,  and  the  secondary 
fever  is  short  and  mild.  The  desiccation  and  removal  of  the 
crusts  or  scabs  is  also  rapid,  so  that  by  the  twelfth  to  the  fif- 
teenth day  the  surface  is  pretty  well  freed  from  them. 


VARIOLA   VACCINA.  '  201 

It  is  not  necessary  to  give  the  treatment  of  varioloid,  as  it 
would  be  but  a  repetition  of  tliat  just  given  under  the  head  of 
small-pox. 

VAEIOLA  VACCINA-COW-POX. . 

Prior  to  the  year  1721,  no  prophylaxis  against  small-pox  was 
known  in  Europe,  if  we  except  the  practice  of  buying  the  small- 
pox that  prevailed  at  a  very  early  period  both  in  Wales  and 
Scotland,  and  which,  in  fact,  was  inoculation.  The  practice  of 
inoculation,  according  to  the  statements  of  the  Jesuits,  was  em- 
ployed immeraorially  in  China,  and  by  the  simplest  method,  that 
of  passing  a  needle  charged  with  the  virus  through  the  skin  when 
it  was  pinched  up  by  the  finger.* 

The  practice  of  inoculation  was  introduced  into  England  in 
1721,  by  Lady  Mary  Montague,  who  had  witnessed  its  success  in 
Turkey,  and  had  a  son  successfully  inoculated.  The  practice  met 
with  much  opposition,  as  all  innovations  upon  established  cus- 
toms and  prejudices  do,  and  it  was  not  until  about  the  year  1750, 
that  it  received  the  cordial  support  of  the  medical  profession.  At 
first  a  stimulant  and  heating  treatment  was  pursued,  as  was  the 
case  in  small-pox,  and  the  mortality  was  considerable.  After- 
ward a  "  refrigerant  and  reducing"  plan  was  adopted,  which  was 
attended  with  much  success,  and  from  this  time  the  practice  came 
to  be  regarded  with  favor. 

The  vaccine  disease  or  cow-pox,  as  a  prophylactic  against 
small-pox,  was  discovered  about  the  year  1775,  by  Dr.  Jenner, 
though  he  did  not  publish  it  until  1798.  He  noticed,  while  first 
studying  medicine,  that  in  the  dairy  districts  of  Gloucestershire, 
there  was  a  current  opinion  that  persons  who  had  been  affected 
with  a  peculiar  eruption  known  as  cow-pox,  were  protected 
against  the  contagion  of  small-pox,  and  might  go  among  it  and 
nurse  persons  affected  with  it,  with  perfect  immunity.  His  mind 
was  strongly  impressed  with  these  facts,  and  he  commenced  their 
investigation.  It  was  not  until  1796,  however,  that  he  became 
sufficiently  convinced  to  attempt  the  propagation  of  the  disease 
by  inoculation,  or  as  we  say,  by  vaccination.  His  first  case  was 
entirely  successful,  the  disease  was  transmitted,  the  pustules 
formed  as  described,  and  two  months  afterwards,  upon  being 
inoculated  with  small-pox  virus,  it  was  found  not  to  have  the 
slightest  influence. 


202  DISEASES   OF    CHILDREN. 

Dr.  Good,  ill  his  study  of  mediciive,  writing  about  the  year 
1822,  gives  the  followiug  account  of  the  discovery,  which,  as  a 
matter  of  historical  interest,  I  quote  :  "  The  disease  attracted 
attention  in  the  county  of  Dorset,  about  forty  or  fifty  years  since, 
as  a  pustular  eruption  derived  from  infection  chiefly,  showing 
itself  on  the  hands  of  milkers  who  had  milked  cows  similarly 
disordered.  It  had  been  found  to  secure  persons  from  the  small- 
pox ;  and  so  extensive  was  the  general  opinion  upon  this  subject 
even  at  the  time  before  us,  that  an  inoculator,  who  attempted  to 
convey  the  small-pox  to  one  who  had  been  previously  infected 
with  the  cow-pox,  was  treated  with  ridicule.  A  formal  trial  was 
made,  however,  and  it  was  found  that  no  small-pox  ensued. 
About  the  same  time,  a  farmer  of  sagacity,  of  the  name  of  Nash, 
duly  attending  to  these  facts,  had  the  courage  to  attempt  artifi- 
cial inoculation  on  himself;  and  the  attempt  is  said  to  have  suc- 
ceeded completely.  Similar  facts  and  numerous  examples  of 
them  were  accordingly  communicated  to  Sir  George  Baker,  who, 
having  engaged  not  long  before  in  a  most  benevolent,  though 
highly  troublesome  controversy  respecting  the  cause  of  the  en- 
demical  colic  of  Devonshire,  was  unwilling,  notwithstanding  his 
triumph,  to  tread  again  the  thorny  paths  of  provincial  etiology. 
Gloucestershire,  however,  another  dairy  county,  had  witnessed 
the  same  disease  with  similar  consequences;  and  the  same  opinion 
generally  prevailing  in  distant  districts  of  both  counties,  afforded 
proof  that  the  power  thus  ascribed  to  cow-pox  was  not  wholly 
visionary. 

"  Dr.  Jenner,  then  resident  at  Berkley,  in  Gloucestershire, 
pursued  this  hint  with  great  judgment  and  unabated  ardor.  He 
was  at  first  foiled  by  not  distinguishing  between  the  genuine 
cow-pox  and  an  ineffective  modification  of  it,  or  a  spurious  dis- 
ease of  nearly  similar  appearance,  to  which  the  same  animal  is 
subject,  but  which  is  no  preservative  against  the  small-pox ;  and 
found  another  difficulty  in  determining  the  period  of  time  within 
which  the  vaccine  virus  maintains  its  prophylactic  power.  Hav- 
ing at  length  made  himself  master  of  the  distinctive  characters 
of  the  genuine  vesicle,  he  ventured  to  publish  the  discovery  in 
1798,  and  to  recommend  inoculation  with  the  virus  of  vaccinia 
as  a  substitute  for  variola." 

The  discovery  was  not  received  by  acclamation,  and  its  discov- 
erer hailed  as  a  benefiictor  of  his  race,  as  many  persons  would 
'imagine  ;  but,  on  the  contrary,  it  was  met  by  ridicule  and  denun- 


VACCINATION.  203 

ciation,  and  Dr.  Jenner  lost  business  and  property,  and  narrowly 
escaped  personal  injury  several  times  at  the  hands  of  a  mob. 
The  medical  profession  was  as  slow  to  admit  the  truth  of  the 
discovery,  and  as  fast  to  cast  obloquy  on  the  discoverer,  as  the 
people ;  and  it  was  many  years  before  the  doctrine  and  the  man 
were  admitted  to  be  orthodox. 

The  disease  of  the  cow  is  of  rather  rare  occurrence,  even  in 
England,  and  hardly  ever  manifests  itself  except  when  cattle  are 
gathered  together  in  herds.  We  have  no  authentic  account  of  it 
ever  having  prevailed  out  of  England,  and  feel  sure  that  it  has 
not  occurred  in  this  country.  The  supposition  that  it  is  small- 
pox modified  by  passing  through  the  cow  is  an  error  reproduced 
every  few  years,  generally  to  make  a  sale  for  vaccine  virus  from 
some  particular  person.  Dr.  Jenner  thought  that  he  had  traced 
the  cause  of  the  disease  of  the  cow  to  the  grease  of  horses.  In 
regard  to  this  Dr.  Good  remarks :  "  It  was  fortunate  for  Dr. 
Jenner,  and  the  triumph  of  his  discovery,  that  a  minuter  attention 
to  the  subject  gave  sufficient  proof  that  there  was  no  foundation 
for  this  opinion  ;  and  that  whatever  be  the  prophylatic  power  of 
the  matter  of  the  disease  called  grease,  this  disease  is  by  no 
means  the  origin  of  the  natural  cow-pox,  and  has  no  connection 
with  it." 

Vaccination. — Vaccination  is  not  so  easy  an  operation  as 
thought  by  the  majority  of  physicians.  True,  it  is  very  simple, 
and  there  should  be  no  reason  for  want  of  success,  when  good 
virus  is  used  ;  yet  an  extended  acquaintance  with  physicians  of 
all  schools,  proves  that  from  its  imperfect  or  careless  perform- 
ance, it  fails  fully  one-half  the  time. 

The  causes  of  failure  are  two-fold.  In  one  case  the  skin  is 
not  so  abraded  as  to  bring  the  virus  in  contact  with  the  true  skin, 
where  it  may  be  absorbed.  In  the  other  the  punctures  are  so  deep 
as  to  cause  a  free  flow  of  blood,  and  the  virus  is  washed  away. 

A  very  simple  and  good  method  is,  exposing  the  arm  at  the 
insertion  of  the  deltoid,  make  the  skin  tense  with  one  hand,  and 
holding  the  lancet  in  the  other  at  an  acute  angle  with  the  arm, 
make  many  slight  punctures  over  a  part  as  large  as  a  three  cent 
piece,  elevating  the  epidermis  without  much  bleeding.  Now  take 
the  virus,  softened  to  the  consistence  of  cream,  and  spread  on 
the  punctures,  either  letting  it  dry  by  exposure  to  tiie  air,  or  cov- 
ering it  with  adhesive  plaster,  before  the  sleeve  is  drawn  down. 


204  DISEASES  OF   CHILDREN. 

Wheu  there  is  a  failure  with  the  lancet  used  iu  this  way,  try 
the  Chinese  method.  Charge  a  fine  needle  with  the  snrus,  raise 
a  portion  of  the  skin  between  the  thumb  and  finger  and  pass  the 
needle  through.  An  instrument  has  been  devised  for  this  pur- 
pose, which  answers  well,  being  speedy,  certain,  and  not  painful. 
It  consists  of  a  small  cupped  stylet,  thrown  by  a  spring ;  the 
virus  being  placed  in  the  cup,  and  the  spring  drawn  back,  it  is 
discharged  into  the  skin  with  a  single  stroke. 

Formation  of  the  Vaccine  Vesicle. — As  a  general  rule,  the  punc- 
ture disappears  the  second  day,  but  about  the  fourth  or  fifth  day, 
a  minute  inflamed  spot  is  seen.  This  gradually  increases  in  size, 
and  is  swollen  and  hardened,  and  forms  the  base  of  the  vesicle, 
which  is  seen  first  about  the  sixth  day.  At  first  it  is  spherical 
and  filled  with  a  transparent  limpid  fluid,  but  as  it  increases  in 
size  it  becomes  flattened,  and  when  it  attains  maturity  the  center 
is  lower  than  the  circumference. 

It  requires  twelve  or  fifteen  days  from  vaccination  for  the  full 
dev^elopment  of  the  vesicle,  which  now  presents  the  following 
appearance :  It  is  regular  in  its  outline,  being  usually  ovoid, 
though  sometimes  circular  in  form.  The  vesicle  is  uniform  in 
its  elevation,  usually  about  one-eighth  of  an  inch,  is  flattened,' 
or  even  depressed  at  the  center,  and  has  a  peculiar  pearly-gray 
color.  It  stands  upon  an  indurated  and  inflamed  base,  which, 
forms  a  red  areola  of  from  half  an  inch  to  an  inch  outside  of  the 
vesicle. 

About  the  twelfth  day  of  the  vesicle  desiccation  commences, 
and  in  four  or  five  days  is  complete,  though  the  scale  or  scab  is 
not  loosened  for  some  time. 

The  scar  left  by  vaccination  is  peculiar,  yet  is  simulated  by 
spurious  vaccination.  It  remains  white,  the  skin  seeming  to  be 
deprived  of  its  rete  mucosum  or  colored  layer,  is  depressed,  the 
outlines  being  clean  cut  and  well  defined,  and  presents  many 
little  pits  or  depressions  into  the  true  skin. 

Generally  there  is  slight  febrile  reaction  about  the  eighth  day, 
when  the  vesicle  has  attained  its  maturity.  Occasionally  there 
is  a  marked  chill,  nausea  and  vomiting,  and  for  a  few  hours  the 
child  is  quite  sick.  Sometimes  the  irritation  of  the  arm  extends  to 
the  axillary  glands,  and  these  become  enlarged  and  painful,  and 
in  some  exceptional  cases  they  have  been  known  to  suppurate. 

Spurious  Vaccination. — Any  deviation  from  the  course  above 
described  may  be  designated  as  spurious,  and  will  not  prove  pro- 


VARIOLA  VACCINIA.  205 

tective.  Regular  in  form,  uniform  and  even  border,  flattened  and 
of  equal  elevation,  slight  depression  in  the  center,  pearly-gray  in 
color,  uniform  2:>eriod  of  development  about  nine  day^,  gradual 
and  even  desiccation,  and  slow  detachment  of  the  crust.  This  is  the 
vaccine  eruption,  and  is  so  distinctive  that -I  think  it  need  not 
be  mistaken. 

Spurious  vaccine  matter  is  produced  in  several  ways.  It  may 
be  from  decomposition  of  the  vaccine  lymph,  by  keeping,  especi- 
ally when  moistened,  and  carried  in  the  pocket,  where  the  tem- 
perature will  be  high.  I  was  acquainted  with  an  example  of 
this  kind,  in  which  a  suppurative  disease  in  some  half  dozen 
children  was  produced  by  such  lymph.  The  most  common 
cause,  as  I  believe,  is  the  use  of  second  crusts  from  the  vaccine 
vesicle.  In  many  cases  the  vesicle  having  fully  developed,  the 
lymph  commences  to  desiccate,  but  before  completion  the  par- 
tially-formed scab  is  rubbed  off  or  is  removed  by  some  accident. 
But  another  one  shortly  forms,  principally  from  pus  secreted  as 
the  result  of  the  irritation.  Of  course,  if  this  should  be  used 
for  vaccination  we  would  introduce  pus  instead  of  vaccine  lymph. 

If  the  general  health  was  deteriorated  in  such  person,  and  the 
blood  was  bad,  and  they  were  suffering  from  any  cachectic  dis- 
ease, the  results  of  such  vaccination  might  be  very  unpleasant. 
For  in  some  of  these  cases  the  pus  possesses  a  peculiar  septic 
property,  that  will  cause  extensive  ulceration.  I  am  satisfied 
that  this  was  the  case  in  the  spurious  vaccination  (from  the 
army)  that  was  propagated  through  many  sections  of  our  country, 
and  was  regarded  by  some  as  syphilitic.  In  every  case  that  I 
could  trace,  the  soldiers  vaccinated  had  been  in  the  hospital,  with 
health  broken  down  by  the  fatigues,  privations,  and  sometimes 
dissipations  of  the  army.  Even  when  the  vaccination  was  good 
and  protective,  which  was  not  often  the  case,  a  suppurative  in- 
flammation followed  at  the  site  of  the  vaccine  vesicle,  and  the 
scabs  formed  contained  pus  from  bad  blood. 

I  had  a  very  marked  example  of  such  spurious  vaccination, 
in  my  own  practice.  A  daughter  of  mine,  in  perfect  health,  was 
visiting  her  grandmother,  and  a  case  of  small-pox  having  oc- 
curred in  the  village,  people  became  excited,  and  almost  the 
entire  population  was  vaccinated.  A  young  lady  employed  in 
the  house,  having  a  very  perfect  vaccine  vesicle,  the  child  was 
vaccinated  with  lymph  from  her  arm,  and  it  also  took  well,  and 
developed  regularly,  and  was  as  perfect  as  was  possible.     But,  a 


206  DISEASES   OF   CHILDREN. 

couple  of  days  before  coming  home,  while  playing  with  other 
children,  she  struck  her  arm,  and  the  partly-formed  scab  was 
detached.  •  But  a  new  one  forming,  it  looked  well  when  I  ex- 
amined it,  and  as  there  could  be  no  doubt  of  the  health  of  both 
the  parties,  I  concluded  that  I  would  use  it  in  my  practice  in 
place  of  others.  The  winter  course  of  lectures  had  just  com- 
menced, and,  as  usual,  I  vaccinated  a  majority  of  the  students, 
using  this  virus.  It  did  not  produce  the  characteristic  vaccine 
disease  in  a  single  instance,  but  quite  a  number  had  very  sore 
arms.  Four  were  so  severely  affected  as  to  be  confined  to  their 
rooms,  and  in  one  the  local  ulceration  and  infiltration  of  tissue 
was  such  that  I  feared  the  gentleman  would  lose  his  arm,  if  not 
his  life ;  but,  having  a  good  constitution,  he  recovered. 

This  unpleasant  experience  has  caused  me  to  be  very  careful 
in  the  use  of  vaccine,  and,  under  no  circumstances,  will  I  em- 
ploy a  second  scab,  whether  the  first  has  been  detached  naturally 
br  by  some  injury. 

Can  Syphilis  be  Transmitted  by  Vaccination  ? — I  answer  this 
question  in  the  negative,  to  this  extent — that  the  use  of  vaccine 
'lymph  will  never  convey  the  disease.  To  make  the  answer 
plainer,  where  the  vaccine  disease  runs  its  regular  course,  and 
the  vesicle  formed  presents  all  the  characteristics  of  that  de- 
scribed, the  lymph  from  this  is  like  pure  gold,  and  is  not  influ- 
enced by  any  constitutional  peculiarity  or  any  disease  of  the 
patient. 

But  if  it  varies  from  this  standard,  is  irregular  in  form  and 
elevation,  and  yellowish  or  pus-like  in  color,  then  disease  may 
be  transmitted,  for  it  is  not  vaccine,  but  something  else.  Or,  if 
running  the  normal  course  of  the  vaccine  disease,  there  is  after- 
ward irritation  and  ulceration,  pus  being  formed,  this  may  be  in 
such  quantity  in  the  scab,  especially  at  its  base,  as  to  be  a  cause 
of  disease.  Or  if  the  first  scab  is  detached  by  injury,  the  second 
one,  being  formed  principally  of  pus,  the  use  of  this  for  vacci- 
nation may  transmit  disease  from  one  to  another. 

For  many  years  the  medical  world,  following  the  lead  of 
Ricord,  denied  that  secondary  lesions  were  transmissible.  Hence, 
syphilis  could  not  be  transmitted  as  above,  unless  there  was  a 
primary  source  at  the  part  of  vaccination,  which  could  only 
occur  by  careless  handling  of  a  person  having  the  primary  dis- 
ease upon  the  genitals.  Bat  it  is  now  conclusively  proven,  and 
even  Ricord  admits,  that  certain  secondary  lesions  may  be  trans- 


RUBEOLA.  /  2»j7 

mitted  by  inoculation,  and  among  these  are  pustular  eruptions. 
Thus  we  have  an  additional  reason  for  care  that  the  lymph 
we  use  is  the  normal  and  regular  product  of  good  vaccination. 
This  we  can  always  determine,  while  it  would  not  be  possible  for 
us  to  learn  or  discover  constitutional  taints  upon  the  part  of 
many  patients. 

That  our  population  is  being  slowly  and  insidiously  infected 
with  syphilis,  through  vaccination,  as  some  would  have  us  be- 
lieve, has  no  foundation  in  fact.  On  the  contrary,  the  spread  of 
the  disease  depends  upon  the  licentiousness  of  the  people,  especi- 
ally the  young  men  of  the  country,  and  the  want  of  laws  regulat- 
ing houses  of  prostitution. 

Preservation  of  Vaccine  Lymph. — Vaccine  lymph  undergoes 
spontaneous  decomposition,  or  at  least  loses  its  specific  properties 
in  a  period  varying  from  two  to  eight  weeks.  Hence  extra  pre- 
cautions are  required  to  preserve  it  from  season  to^season.  It  is 
most  convenient  to  vaccinate  from  the  crust  or  scab,  and  this  is 
most  commonly  used.  For  a  short  time  it  may  be  kept  between 
two  pieces  of  wax,  or  inclosed  in  this  manner,  additional  security 
may  be  given  by  an  envelope  of  tin-foil.  But  when  we  wish  to 
keep  it  through  the  summer,  we  envelop  the  scab  in  tin-foil, 
pressing  it  down  tightly,  so  as  to  render  it  water-proof,  and  drop 
it  into  a  bottle  of  glycerine.  I  do  not  know  how  long  it  might 
be  preserved  in  this  way,  but  I  have  kept  it  in  an  active  condi- 
tion for  a  year. 

RUBEOLA— MEASLES. 

Measles  is  a  disease  of  childhood,  though  it  may  occur  at  any 
age,  and  becomes  more  dangerous  as  the  person  is  advanced  in 
years.  Like  the  other  eruptive  fevers  it  is  caused  by  a  specific 
contagion  developed  during  the  progress  of  the  disease,  and  may 
be  propagated  in  the  same  way,  by  contact  or  by  breathing  an 
atmosphere  impregnated  with  the  poison.  Like  the  others,  it 
also  prevails  in  cycles  of  from  five  to  seven  years.  In  some  sea- 
sons and  localities  it  will  appear  in  a  very  mild  form,  while  in 
others  it  will  be  more  or  less  malignant. 

Symptoms. — From  seven  to  fourteen  days  after  exposure,  the 
disease  is  ushered  in  with  a  chill,  sometimes  slight,  at  others 
amounting  to  a  rigor.  Occasionally  for  a  day  or  two  before  this 
tiie  child  manifests  catarrhal  symptoms,  has  a  slight  cough,  and 


208  ^  DISEASES   OF   CHILDEEN. 

may  complain  of  pain  in  the  head  and  back.  Following  the  chill, 
febrile  reaction  comes  up,  but  varies  greatly  in  different  cases. 
In  some  it  is  quite  active,  with  a  flushed  hot  skin,  frequent,  full 
hard  pulse,  and  considerable  irritability  of  the  nervous  system. 

In  all  cases  the  catarrhal  symptoms  are  so  prominent  and 
constant,  as  to  be  regarded  as  almost  pathognomonic.  About  the 
time  of  the  chill,  the  child  seems  to  have  taken  a  severe  cold, 
sneezes  frequently,  stuffing  up  of  the  nose,  with  increased  secre- 
tion and  discharge,  redness  and  watering  of  the  eyes,  increased 
sensibility  to  light,  hoarseness,  and  a  troublesome  dry  bronchial 
cough. 

The  febrile  reaction  is  usually  remittent,  and  continuing  to 
increase  gradually  to  the  second,  third,  or  fourth  day,  then  de- 
clines after  the  eruption  has  fully  made  its  appearance.  The 
eruption  comes  out  first  on  the  face,  neck  and  breast,  then  on  the 
balance  of  the  trunk,  and  finally  upon  the  extremites.  The 
single  point  of  eruption  is  much  the  color  of  a  musquito  bite, 
ovoid  or  irregular  in  form,  especially  irregular  in  its  border, 
and  the  color  is  gradually  shaded  off  to  the  color  of  the  skin. 
The  points  of  eruption  generally  coalesce,  so  as  to  present  larger 
patches  or  blotches.  In  very  severe  cases,  the  whole  surface  will 
be  thus  covered  so  as  to  present  but  little  of  sound  skin.  The 
eruption  is  slightly  elevated,  and  rough  when  the  finger  is  passed 
over  it,  and  pressure  momentarily  removes  the  color. 

It  requires  from  twenty- four  to  seventy-two  hours  for  the  full 
appearance  of  the  eruption.  It  retains  about  the  same  degi'ee  of 
redness  for  one  or  two  days,  and  then  slowly  declines,  so  that  about 
the  sixth  to  the  ninth  day  from  the  chill,  it  has  passed  away. 

During  the  one,  two  or  three  days  in  which  the  eruption  is 
coming  upon  the  surface,  the  fever  is  higher  than  before,  and 
sometimes  the  little  patient  is  quite  sick,  even  in  the  ordinary 
form  of  the  disease.  Then  it  declines,  sometimes  slowly,  re- 
appearing at  times  until  the  efflorescence  has  entirely  passed 
away ;  at  others,  the  little  patient  will  be  free  from  it  in  the 
course  of  a  day. 

Witli  the  appearance  of  the  eruption  the  bronchial  irritation 
and  cough  are  markedly  increased  in  some  cases,  and  become 
very  troublesome.  There  is  also  more  or  less  difficulty  of  breath- 
ing, which  sometimes  depends  upon  determination  to,  or  conges- 
tion of  the  bronchial  tubes,  and  at  otliors  upon  similar  lesions 
of  the   parenchyma    of  the  lungs.     The  part  affected,   and  also 


RUBEOLA.  209 

the   character   of  the   lesiou,    may  be   determined   by   physical 
examination. 

Malignant  Rubeola. — As  named  above,  measles  prevail 
with  varying  degrees  of  severity,  from  the  very  mild  to  the  most 
malignant.  We  will  also  find  that  all  the  cases  of  a  season  re- 
semble one  another — when  the  disease  is  mild,  all  cases  are 
mild — when  it  is  severe,  all  cases  are  severe.  Of  the  cause  of 
this  malignancy  we  know  but  little,  further  than  that  the  conta- 
gious virus  once  attaining  malignancy,  propagates  itself  in  the 
same  way. 

In  one  class  of  cases  the  eruption  is  tardy  in  its  appearance; 
the  fever  running  a  pretty  active  course,  with  considerable 
bronchial  disturbance,  the  third,  fourth,  fifth,  or  sixth  day  passes 
without  its  full  appearance.  The  surface  seems  slightly  swollen 
and  flushed,  and  in  some  places  the  eruption  is  seen  indistinct  as 
if  struggling  to  make  its  appearance.  In  the  children  of  my 
own  family,  the  eruption  made  its  appearance,  respectively,  in 
five,  eight,  and  thirteen  days  from  the  chill. 

Necessarily,  in  such  cases  the  blood  must  become  impaired  by 
the  long  retention  of  the  rubeolous  poison,  and  the  symptoms 
presented  will  be.  more  or  less  of  a  typhoid  character. 

In  another  class  of  cases,  the  symptoms  of  malignancy  are 
manifested  early  in  the  disease.  The  pulse  is  smaller  and  faster, 
the  skin  flushed,  but  dry  and  husky,  and  the  tongue  covered  with 
a  dirty  fur  with  a  tinge  of  brown.  The  nervous  system  suffers 
especially  in  these  cases.  In  some  there  is  great  excitement  for 
the  first  day  or  two,  even  delirium,  or  occasionally  convulsions, 
afterwards  coma.  But  in  the  majority  of  cases  dullness  and 
hebetude  are  marked  symptoms,  the  child  dozes  with  its  eyes 
partly  open,  and  early  coma  comes  on  and  gradually  increases 
until  the  child  can  not  be  aroused  from  it. 

In  all  of  these  severe  cases  the  eruption  is  more  or  less  dusky, 
and  we  may  judge  very  closely  of  the  severity  of  the  disease  by 
this.  It  will  also  be  a  guide  in  the  treatment.  Means  that 
brighten  the  color  of  the  eruption  are  beneficial,  but  if  the 
duskiness  increases,  we  may  be  satisfied  that  our  treatment  is 
productive  of  no  benefit. 

Retrocession. — There  may  be  a  retrocession  of  the  eruption 
of  measles,   at  any  time  after  it  has  appeared.     In  the  milder 
form  of  the  disease,  this  increases  the  fever  and  the   bronchial 
14 


210  DISEASES   OF   CHILDREN. 

irritation,  and  though  unpleasant  is  not  dangerous.  But  in  other 
cases  we  will  find  the  nervous  system  suffering  severely  from  the 
retrocession,  and  if  it  continues  the  blood  also  becomes  impaired. 
In  these  cases  dullness,  stupor,  and  coma  follow  one  another 
rapidly;  the  skin  is  dusky,  the  temperature  increased,  and  the 
tongue  soon  becomes  brown,  and  sordes  appear  upon  the  teeth. 
These  symptoms  are  of  a  grave  character,  and  unless  prompt 
means  are  employed  to  bring  the  eruption  again  upon  the  sur- 
face, it  may  terminate  fatally  in  a  short  time. 

The  Sequel.^  of  Measles. — An  irritation  of  the  bronchial 
tubes  and  larynx,  with  a  harassing  cough,  is  very  frequently  left 
from  measles.  In  some  cases  this  seems  to  be  the  result  of  cold 
taken  during  the  progress  of  the  disease,  or  more  frequently, 
shortly  after  the  child  has  commenced  getting  about.  The  cough 
is  very  harassing,  causes  restlessness  and  broken  sleep,  affects 
the  appetite  and  digestion,  and  indeed,  all  of  the  vital  functions. 
Continuing,  the  bronchial  irritation  produces  structural  change, 
and  after  a  time  develops  true  phthisis. 

A  less  common  sequel  of  measles,  is  a  subacute  inflammation 
of  the  conjunctiva,  principally  confined  to  the  lids,  and  finally 
terminating  in  granular  lids,  or  ophthalmia  tarsi. 

In  some  other  cases,  otorrhoea  results,  and  proves  very  stub- 
born. Deafness,  partial  or  total,  may  also  be  produced  by 
measles.  The  partial  deafness  is  usually  owing  to  disease  of  the 
Eustachian  tubes,  though  it  is  sometimes  of  the  middle  ear. 

Diagnosis. — The  marked  catarrhal  symptoms  is  the  principal 
diagnostic  feature  in  the  early  stage  of  this  disease,  as  the  severe 
pain  is  in  small-pox,  and  the  sore  throat  in  scarlet  fever.  We 
distinguish  the  eruption  by  its  irregular  form,  coalescing  in 
blotches,  not  presenting  the  hardness  of  small-pox,  or  the  vivid 
redness  of  scarlet  fever. 

Prognosis. — The  prognosis  in  measles  is  favorable ;  even  in 
the  malignant  cases,  if  properly  treated,  there  should  be  but  a 
small  mortality.  It  is  true  that  in  some  epidemics  in  large  cities, 
the  disease  is  very  severe  and  typhoid  in  its  character,  yet  I 
think  that  the  great  mortality  attending  it  is  to  be  attributed  to 
the  medication  as  much  as  to  the  disease. 


RUBEOLA.  '     211 

Treatment. — The  treatment  of  measles  is  usually  very  simple. 
Bathe  the  patient's  feet  for  half  an  hour  in  hot  water,  and  give 
internally  an  infusion  of  two  parts  of  Aselepias  and  one  of 
Lobelia  herb.  It  ne^d  not  be  given  to  produce  nausea,  though 
to  the  extent  of  slight  nausea  it  favors  the  appearance  of  the 
eruption.  After  the  eruption  has  made  its  appearance  I  fre- 
quently continue  the  same  remedy  in  small  doses,  to  relieve  the 
bronchial  irritation  and  check  the  cough. 

In  place  of  this  we  may  put  the  patient  upon  the  use  of  Vera- 
trum  or  Aconite,  in  small  doses,  with  gtt.  x.^ogtt.  xx.  of  Lobelia 
to  water  Siv.,  using  the  general  sponge-bath  at  first,  and  the  hot 
foot-bath  to  favor  their  action.  This  is  not  associated  with  warm 
teas  and  stimulants  as  so  commonly  used,  but  on  the  contrary 
the  patient  is  kept  quiet  in  bed,  not  too  warmly  covered,  and  is 
allowed  cool  drinks. 

If  the  cough  is  very  troublesome,  we  may  give  an  infusion  of 
dried  red  clover,  or  from  the  pocket  case,  Tinct.  Drosera  gtti  x. 
to  gtt.  XX.,  water  Siv.,  a  teaspoonful  every  three  hours.  If  there 
is  anything  specific  in  medicine  it  will  be  found  in  the  use  of 
Drosera  in  the  cough  of  measles  and  in  whooping  cough. 

In  some  cases  we  find  the  patient  very  restless,  starting  in 
sleep,  with  shrill  cry,  and  we  fear  convulsions.  The  pulse  is 
small  and  sharp,  and  the  skin  dry,  contracted  and  burning.  The 
remedy  here  will  be  Rhus,  and  its  action  is  very  prompt  and 
kindly.  Gelseminum,  Bryonia,  Apis,  Phytolacca,  Eupatorium, 
and  other  remedies,  will  find  a  place  in  the  treatment  of  this  dis- 
ease, being  guided  by  the  special  indications  as  heretofore  given. 

When  bronchial  irritation  is  great,  or  passed  into  the  state  of 
inflammation,  we  will  find  the  use  of  an  inhalation  of  the  vapor  of 
water,  either  alone,  or  medicated  with  Lobelia,  or  with  some  of 
the  narcotics,  will  answer  a  better  purpose  than  the  usual  inter- 
nal remedies.  A  mush  poultice  applied  to  the  chest  in  older 
children,  and  continued  until  the  irritation  is  relieved,  answers 
a  good  purpose.  But  with  young  children  I  prefer  a  cloth 
spread  with  lard,  and  sprinkled  with  the  emetic  powder  of  the 
Dispensatory. 

Much  care  is  required  after  the  disease  has  subsided  in  order 
to  confirm  convalescence.  The  clothing  should  be  warm,  and 
the  child  not  permitted  to  expose  itself  to  draughts  of  air.  If 
this  is  attended  to  and  the  secretions  kept  free,  there  is  no  more 
danger  from  measles  than  from  any  other  disease. 


212  DISEASES  OF  CHILDREN. 

In  malignant  rubeola  we  will  have  to  give  the  case  closer  atten- 
tion. The  first  evidence  of  the  character  of  the  disease  in  young 
children  will  be  manifested  in  the  stupor  and  tendency  to  coma. 
This  will  be  met  by  the  use  of  Belladonna,with  Aconite,  in  the 
doses  heretofore  named.  Though  the  case  seems  grave  to  trust 
to  such  small  doses,  yet  a  considerable  experience  has  given  me 
great  confidence  in  Belladonna  as  a  specific  against  congestion, 
especially  of  the  nervous  system. 

With  this  I  put  the  patient  upon  the  use  of  the  anti-zyraotics, 
to  antagonize  the  septic  condition  of  the  blood ;  either  of  these 
remedies  may  be  indicated.  Sulphite  of  soda,  if  the  tongue  is 
broad,  pallid  and  dirty  ;  sulphurous  acid,  if  it  is  deep-red  and 
moist,  and  covered  with  a  glutinous  nastiness ;  muriatic  acid,  if 
it  is  deep-red,  contracted,  dry  and  covered  with  a  brown  coat; 
Baptisia,  if i  the  patient  shows  that  full  livid  face  as  of  one  ex- 
posed to  severe  cold ;  and  chlorate  of  potash,  if  we  have  the 
peculiar  odor  as  from  cynanche  maligna. 

When  the  eruption  is  tardy  in  making  its  appearance,  the 
patient  being  depressed,  with  stupor  or  coma,  we  may  place  great 
dependence  upon  the  action  of  an  emetic.  Or  when  a  retroces- 
sion of  the  eruption  takes  place,  with  the  same  symptoms,  it  is 
the  most  certain  means  of  treatment.  I  prefer  in  these  cases  the 
acetous  emetic,  and  give  it  so  as  to  get  a  gradual  influence  upon 
the  system,  then  carry  it  to  thorough  emesis. 

This  may  be  followed  by  the  Aconite  and  Belladonna,  and  the 
sulphite  of  soda,  as  named  above. 

To  arrest  the  harassing  cough  that  so  frequently  remains  after 
the  eruption  has  disappeared,  I  prefer  either  the  infusion  of 
clover  hay,  as  before  named,  or  the  Tinct.  of  Drosera  5ss.,  to 
water  Siv.,  a  teaspoonful  every  four  hours.  These  remedies  will 
be  found  much  better  than  the  ordinary  cough  medicines  in  use. 

SCARLATINA. 

This  is  essentially  a  disease  of  childhood,  and  few  persons  will 
take  it  after  the  age  of  twenty.  Unlike  measles,  it  is  also  milder, 
as  the  patient  is  older.  It  is  propagated  by  a  specific  contagion, 
either  by  inhaling  the  exhalations,  or  contact  with  the  clothes 
of  the  patient.  In  some  seasons  it  becomes  epidemic;  doubtless 
because  the  poison  is  so  intense  as  to  be  propagated  readily  and 
at  a  considerable  distance,  and  the  condition  of  the  atmosphere 


SCARLATINA.  •  213 

is  favorable  to  the  ready  propagation  of  a  zymotic  disease.  Scar- 
latina has  been  divided  into  three  forms  :  S.  Simplex,  S.  Angi- 
nosa^  and  S.  Maligna,  differing  in  their  intensity,  severity  of 
symptoms  and  fatality.  In  some  seasons  the  disease  will  present 
the  character  of  the  first  exclusively,  in  others  it  will  be  of  the 
anginose  form,  and  again  every  case  will  be  malignant. 

Symptoms. — From  six  to  eight  days  elapse  after  exposure  be- 
fore the  disease  makes  its  appearance,  and  it  is  usually  ushered 
in  with  a  chill.  In  scarlatina  simplex  the  chill  is  not  very  well 
marked,  and  lasts  but  a  short  time.  The  fever  following  presents 
the  common  symptoms,  increased  heat  of  skin,  arrest  of  secre- 
tion, frequent  pulse,  loss  of  appetite,  etc.  In  the  course  of  from 
six  to  twenty-four  hours,  the  eruption  makes  its  appearance,  in 
the  shape  of  patches  of  efflorescence  upon  the  face  and  neck, 
then  extending  to  the  body.  If  the  eruption  is  minutely  ex- 
amined, it  will  he  found  to  consist  of  an  infinite  number  of  small 
red  points,  the  rose-colored  ground  being  simply  the  base  upon 
which  they  stand.  Soreness  of  the  throat,  with  'slight  difficulty 
of  deglutition,  appears  at  the  commencement,  though  not  usually 
severe,  or  accompanied  with  tumefaction.  For  eighteen  to  forty- 
eight  hours  after  the  appearance  of  the  eruption  the  fever  con- 
tinues as  before,  but  then  rapidly  abates,  and  in  from  three 
to  five  days  the  redness  disappears,  and  is  followed  by  branny 
desquamation  of  the  cuticle. 

In  scarlatina  anginosa,  the  chill  is  usually  marked,  there  is 
nausea  and  vomiting,  pain  in  the  head  and  back,  thirst,  etc.  The 
fever  which  follows  is  intense,  the  skin  is  dry,  husky  and  burn- 
ing, the  eyes  dry  and  painful,  the  face  congested  and  tumid, 
bowels  constipated,  urine  is  scanty,  frequently  voided  and  high- 
colored,  with  marked  irritabillity  of  the  nervous  system.  Sore- 
ness of  the  throat,  with  difficult  deglutition,  is  complained  of 
from  the  first,  and  on  examination  we  find  the  fauces  tumid  and 
red,  and  the  tonsils  somewhat  swollen.  The  nares  are  frequently 
implicated  with  the  angina,  and  there  is  consequent  stuffing  of 
the  nose,  with  difficult  respiration  and  increased  restlessness. 

The  eruption  sometimes  makes  its  appearance  during  the 
latter  part  of  the  first  day  of  the  fever,  but  more  frequently  not 
until  the  second  or  third  day ;  about  the  third  or  fourth  day  it 
has  reached  its  hight.  At  the  commencement  there  appears  a 
slight  tumefaction  of  a  portion  of  the  surface,  which  gradiuilly 


214  DISEASES  OF    CHILDREN. 

assumes  a  scarlet  color,  and  the  minute  red  points  are  devel- 
oped. These  patches  increase  in  size  until  the  greater  portion  of 
the  surface  is  involved.  During  the  eruption  there  is  an  ex- 
pression of  anxiety  and  suffering ;  the  child  is  restless  and  uneasy, 
and  sleeplessness,  which  resists  the  usual  means  of  rest,  is  caused 
by  the  heat  and  stinging  of  the  surface  and  soreness  of  the  throat. 

The  throat  affection  is  here  the  most  prominent  feature ;  the 
soreness  increases,  the  mucous  membrane  and  subjacent  tissue 
are  engorged  and  tumid,  and  the  secretion  from  the  mucous 
follicles  and  salivary  glands  so  viscid  and  tenacious  as  to  cause 
great  distress.  In  some  cases,  ulceration  commences  by  the  fifth 
or  sixth  day  of  the  disease,  and  the  secretion  is  difficult  of  re- 
moval and  exceedingly  offensive;  occasionally  the  ulceration 
assumes  a  phagedenic  form,  and  speedily  terminates  the  life  of 
the  patient.  Frequently  enlargement  of  the  cervical  lymphatics 
commences  from  the  third  to  the  sixth  day,  and  if  not  promptly 
treated,  terminates  in  inflammation  and  suppuration.  The  fever, 
under  appropriate  treatment,  commences  to  abate  when  the  erup- 
tion has  made  its  appearance,  and  disappears  entirely  by  the 
fourth  or  sixth  day,  when  desquamation  commences.  As  this 
progresses  the  surface  becomes  paler,  the  epidermis  exfoliating 
in  whitish  scales,  or  in  large  pieces  when  it  is  thick.  Sometimes 
desquamation  is  retarded  for  two  or  three  weeks. 

Scarlatina  maligna  might  be  divided  into  two  kinds,  the  dis- 
tinctive symptoms  being  marked.  In  the  one  case  there  is 
marked  evidence  of  prostration  from  the  commencement.  The 
chill  is  greatly  prolonged,  and  the  child  seems  dull  and  stupid, 
the  countenance  vacant  or  besotted.  Febrile  reaction  comes  up 
slowly,  the  body  becomes  hot,  the  heat  being  pungent,  but  the 
extremities  are  cold.  The  pulse  is  frequent,  but  soft  and  fluent, 
or  else  small  and  wiry.  Frequently  there  is  nausea  and  vomit- 
ing, sometimes  diarrhoea.  The  tongue  is  broad,  flabby,  and  cov- 
ered with  a  foul,  dirty  mucus,  and  the  patient  has  difficulty  in 
controlling  its  movements.  The  eruption  makes  its  appearance 
slowly,  the  redness  being  more  or  less  dusky.  The  throat  affec- 
tion possesses  the  same  characteristics ;  there  is  difficult  degluti- 
tion and  respiration,  the  mucous  membrane  presenting  a  dusky, 
tumid  appearance.  Ulceration  is  of  frequent  occurrence,  their 
surfaces  being  foul,  the  edges  ragged,  and  a  strong  tendency  to 
phagedena.  Enlargement  of  the  cervical  lymphatic  glands  is 
very  common,  with  a  tendency  to  the  formation  of  a  diffusive 


SCARLATINA.  215 

abscess,  and  also,  if  the  patient  lives,  to  the  formation  of  sec- 
ondary abscesses.  As  the  disease  progresses  the  symptoms  are 
all  of  a  typhoid  character ;  there  is  the  dark  tongue,  sordes  on 
the  teeth,  feeble  pulse,  great  oppression  of  the  nervous  system, 
tendency  to  diarrhoea,  tympanitis,  etc. 

In  the  second  case,  the  disease  exhibits  but  few,  if  any,  pre- 
monitory symptoms.  The  child  is  attacked  suddenly;  the  chill 
lasting  but  a  quarter  or  half  an  hour,  is  not  well  marked,  and  is 
succeeded  by  the  most  intense  febrile  reaction.  The  skin  is  in- 
tensely hot,  dry,  and  husky ;  the  mouth  parched  and  dry;  the 
eyes  injected,  dry,  brilliant  and  painful.  The  patient  is  either 
delirious  or  suffers  such  intense  pain  as  to  be  almost  unconscious 
of  what  passes  around  him.  There  is  nausea  and  vomiting,  the 
irritation  being  sometimes  so  intense  that  nothing  can  be  retained, 
on  the  stomach.  In  these  cases  the  patient  is  frequently  ex- 
hausted by  the  intense  reaction,  and  dies  before  the  appearance 
of  the  eruption,  or  during  the  time  that  nature  is  trying  to  throw 
it  on  the  surface. 

In  the  last  two  forms  of  the  disease,  and  sometimes  in  the  simple 
form,  we  observe  a  want  of  power  upon  the  part  of  the  system 
to  determine  the  eruption  to  the  surface.  In  such  case  the  skin 
appears  tumid  and  dusky,  there  is  tendency  to  coldness  of  the 
extremities,  and  marked  oppression  of  the  nervous  system.  In 
such  case,  prompt  measures  must  be  taken  to  bring  the  eruption 
to  the  surface,  or  the  patient  will  die.  Again,  we  observe  cases 
in  which  the  eruption  comes  out,  but,  from  some  cause,  it  retro- 
cedes;  in  this  case  the  same  alarming  symptoms  manifest  them- 
selves. In  other  cases,  the  anginose  affection  is  so  severe  that 
it  seems  that  the  patient  has  not  suiBcient  power  to  carry  on 
respiration;  sometimes  the  difficulty  depends  upon  the  secretion 
of  a  viscid,  tenacious  mucus. 

Diagnosis. — Scarlet  fever  is  diagnosed  from  other  diseases  of 
the  skin  by  the  rose-colored  efflorescence,  upon  which  are  the 
innumerable  small  red  points.  A  marked  characteristic  of  the 
disease  is  the  fact  that  the  redness  is  effaced  by  pressure,  and 
does  not  return  for  some  little  time.  Thus,  by  taking  a  pencil 
or  the  finger-nail  we  can  write  our  name,  which  remains  for  a 
moment,  and  then  gradually  fades  out. 

Prognosis. — In  the  simple  and  anginose  forms  of  the  disease, 
the  prognosis  is  favorable.     In  the  malignant  form,  unless  the 


,216  DISEASES  OF  CHILDEEN. 

treatment  is  prompt  and  effective,  the  prognosis  is  unfavorable. 
In  all  cases,  if  the  eruption  becomes  dusky,  if  coma  or  typho- 
manla  ensue,  or  if  the  tongue  becomes  brown  and  foul,  it  is 
unfavorable. 

Sequels. — Among  the  most  frequent  of  the  sequelae  of 
scarlet  fever,  are  diseases  of  the  kidneys,  consisting  of  simple 
exhaustion  and  want  of  power  to  secrete,  chronic  inflammation 
and  albuminuria.  In  the  first  we  notice  a  marked  dullness  and 
hebetude,  the  appetite  is  poor,  the  bowels  irregular,  marked 
debility  and  tendency  to  cachectic  diseases,  the  blood  being 
greatly  impaired.  In  the  second,  the  pulse  is  hard  and  frequent, 
the  dryness  and  huskiness  of  the  skin  continue,  there  is  pain 
and  soreness  in  the  back  and  loins,  the  appetite  is  poor,  the 
tongue  dry,  whitish,  and  fissured.  In  the  third,  dropsy  makes 
its  appearance  when  the  child  is  supposed  to  be  convalescing. 
Continued  disease  of  the  throat,  with  irritation  and  enlargement 
of  the  cervical  lymphatic  glands,  is  sometimes  observed.  Ozsena, 
with  weakness  and  irritation  of  the  eyes,  and  chronic  disease  of 
the  ears,  attended  by  purulent  discharge  and  partial  deafness,  is 
not  un  frequent.       v 

Teeatment. — In  the  treatment  of  this  disease  it  is  well  to 
have  some  well-defined  line  of  action — to  determine  exactly  how 
we  can  benefit  our  patient.  We  know,  by  experience,  that  the 
higher  the  fever,  and  the  longer  it  continues  before  the  appear- 
ance of  the  eruption,  the  greater  the  danger,  and  that  the  case 
also  becomes  critical  in  proportion  to  the  amount  of  eruption  and 
arrest  of  secretion.  Thus,  in  all  cases,  it  is  good  practice  to  use 
such  means  as  will  control  the  primary  fever,  and  favor  the  early 
appearance  of  the  eruption.  I  have  already  mentioned,  when 
speaking  of  small-pox,  that  keeping  the  secretions  free  during 
this  period  lessened  the  amount  of  eruption ;  this  is  the  case 
here;  hence  depurants  are  advantageous.  Care  must  be  used, 
however,  not  to  overstimulate  either  the  skin,  the  kindeys,  or  the 
bowels.  If  the  first,  we  will  have  too  free  eruption,  and  after- 
ward inaction;  if  the  kindeys,  secretion  may  be  arrested,  or  albu- 
minuria induced  ;  if  the  bowels,  it  may  cause  retrocession  of  the 
eruption,  or  very  great  wrong  of  sympathetic  innervation. 

In  scarlatina  simplex  we  put  the  patient  upon  the  use  of 
Tinet.  of  Aconite  and  Belladonna— the  usual  doses  repeated 
every  hour.     The  alkaline  bath  is  used  sufficiently  often  to  keep 


SCARLATINA.  217 

down  the  heat  of  the  skin,  and  render  it  soft  and  pliable.  If  the 
skin  is  inactive  the  bath  may  be  hot;  sponging  the  child  with 
water  as  hot  as  can  be  borne,  stimulates  the  capillary  circulation, 
and  brings  the  eruption  to  the  surface.  This  may  be  done  before 
the  fire,  covering  the  patient  with  a  blanket,  or  it  may  be  done 
under  the  bed-covering.  It  is  well  to  say  to  the  nurse,  in  these 
cases,  "  if  the  child  complains  of  any  part,  sponge  it  with  hot 
"water,  and  cover  with  dry  flannel." 

Generally  we  will  find  that  these  means  relieve  the  irritation, 
the  fever  is  lessened,  and  the  eruption  comes  out  early ;  and  con- 
tinuing these  for  two  or  three  days,  there  is  but  little  fever  after 
the  eruption  has  made  its  appearance. 

The  treatment  for  the  throat  will  consist  of  the  use  of  occa- 
sional inhalations  of  one  part  of  vinegar  to  three  of  water,  and 
a  flannel  wrung  out  of  equal  parts  of  vinegar  and  water  and  ap- 
plied around  the  throat,  with  a  dry  flannel  over  it ;  this  may  be 
changed  every  half  hour  or  hour,  and  as  the  disease  subsides 
may  be  replaced  with  a  dry  flannel.  In  some  cases  no  applica- 
tion to  the  throat  is  necessary,  patients  doing  better  without  it. 
In  some  Stillingia  liniment  may  be  used  once  a  day. 

In  scarlatina  anginosa  we  adopt  pretty  much  the  same  treat- 
ment. If  the  febrile  reaction  is  high  we  may  add  Veratrum  to 
our  sedative  mixture,  or  Ave  may  substitute  it  for  the  Aconite. 
We  do  not  expect  immediate  sedation,  indeed  it  is  not  desirable, 
but  as  the  remedies  gradually  influence  the  circulation,  many  of 
the  unpleasant  symptoms  pass  away. 

In  some  cases  there  will  be  marked  irritation  of  the  nervous 
system,  with  determination  of  blood  to  the  brain.  In  these  we 
replace  the  Belladonna  with  Gelseminum,  continuing  it  until 
these  symptoms  have  disappeared. 

In  other  cases  there  will  be  marked  indications  for  Rhus,  in 
the  sharp  stroke  of  the  pulse,  pain  in  the  forehead,  starting  in 
the  sleep,  shrill  cry,  etc.  This  remedy  is  also  indicated  by  burn- 
ing of  the  surface,  with  extreme  nervous  irritation,  and  whilst 
it  favors  the  appearance  of  the  eruption,  it  promotes  functional 
activity  of  the  skin.  Apis  will  be  indicated  by  itching  of  the 
surface,  and  pinkish  coloration  of  the  face.  Baptisia  w\\\  be 
suggested  by  the  full  face,  somewhat  dusky,  and  by  duskiness 
of  the  eruption. 

The  disease  of  the  throat,  which  in  this  case  is  the  most  promi- 
nent feature,  will  demand  much  attention.     The  vinegar  pack  is 


218  DISEASES    OF   CHILDREN. 

the  best  external  application  here,  as  it  was  in  the  preceding  case, 
and  should  be  continuously  employed.  The  inhalation  also 
offers  the  best  local  application  to  the  affected  mucous  surface. 
The  simple  inhalation  of  the  vapor  of  water,  or  of  water  and 
vinegar,  or  an  infusion  of  hops,  of  German  chamomile  or  garden 
tansy,  will  give  great  relief,  and  repeated  every  two,  three,  or 
four  hours,  will  be  sufficient  in  many  cases  for  the  permanent 
cure.  When  additional  remedies  are  deemed  necessary,  they  are 
best  prepared  in  powder  with  gum  arabic  and  sugar,  and  allowed 
to  slowly  dissolve  upon  the  tongue.  We  may  thus  use  chlorate 
of  potash,  hydrochlorate  of  ammonia,  sulphite  of  soda,  borax, 
alum,  etc.  Used  in  this  way,  they  relieve  dryness  of  the  throat, 
and  the  constant  desire  to  swallow,  which  is  so  unpleasant. 

If  there  is  a  marked  tendency  to  enlargement  of  the  lym- 
phatic glands,  I  administer  Phytolacca,  alternated  with  the  rem- 
edies that  have  been  named.  It  has  been  my  experience  that  if 
remedies  are  carefully  selected,  we  will  have  but  little  glandular 
trouble.  Phytolacca  is  an  excellent  external  application,  or  in 
place  of  this,  especially  if  suppuration  is  threatened,  a  solution 
of  salicylic  acid  and  borax,  aa.  3j-  to  water  Oj.  may  be  employed. 
Boracic  acid  in  solution,  3j-  to  Oj.  of  water,  is  also  a  good  appli- 
cation. 

In  the  first  case  of  scarlatina  maligna,  I  employ  Aconite  and 
Belladonna  in  the  usual  doses,  using  stimulant  hot  sponge-baths 
and  the  hot  mustard  foot-bath,  to  aid  in  restoring  an  equal  and 
free  circulation  of  blood.  The  indications  for  remedies  are  care- 
fully noted.  Baptisia  is  frequently  indicated  by  duskiness  of 
the  skin  and  even  of  mucous  membranes ;  Rhus  by  the  sharp 
stroke  of  the  pulse,  starting  in  sleep,  and  contraction  about  the 
base  of  the  brain ;  Phytolacca  by  the  soreness  of  mouth  and 
swelling  of  the  cervical  lymphatics ;  Ipecacuanha  by  irritation 
of  the  stomach  and  diarrhoea  ;  Xux  by  the  nausea  and  vomiting, 
associated  with  nervous  prostration,  etc. 

As  typhoid  symptoms  rapidly  develop,  we  select  our  anti-zy- 
motic early,  sometimes  commencing  its  use  at  our  first  visit. 
The  pallid,  dirty  tongue  (not  a  common  case)  is  met  by  sulphite 
of  soda  ;  the  red  tongue,  with  glutinous  dirty  coat,  calls  for  sul- 
phurous acid.  The  latter  remedy  is  indicated  in  a  large  number 
of  cases,  and  is  not  only  one  of  the  best  for  internal  administra- 
tion, but  also  as  a  topical  application  to  the  throat.  In  severe 
cases  it  may  be  used  with  a  spray  apparatus.     Muriatic  acid  may 


SCARLATINA.  219 

be  added  to  the  child's  drink  when  the  indication  is  strong — 
the  deep  red  tongue.  Baptisia  has  already  been  named,  the  in- 
dications being  dusky  coloration  of  face,  surface,  tongue,  and 
throat  Chlorate  of  potash  is  indicated  by  the  peculiar  fetor,  as 
from  cynanche  maligna,  and  may  now  be  used  as  an  internal 
remedy,  as  a  gargle,  or  as  a  spray. 

The  throat  receives  the  same  treatment  as  the  preceding  case 
with  the  addition  of  an  infusion  of  Baptisia  tinctoria  as  a  gargle, 
if  it  can  be  used  in  that  way ;  if  not,  by  a  spray  instrument,  or 
by  inhalation  of  the  vapor.  I  would  also  give  it  internally,  a 
teaspoonful  every  two  or  three  hours.  If  the  throat  is  tumid 
and  dusky,  or  is  ulcerated  and  sloughy,  boracic  acid  or  thymol 
in  solution  will  be  found  an  excellent  application.  The  sulphu- 
rous acid,  one  part  to  four  of  water,  is  also  very  good  Avhen  used 
with  the  spray  apparatus.  In  very  severe  cases,  when  there  is 
marked  torpor  of  the  nervous  system,  with  rapidly  approaching 
coma,  I  prefer  to  commence  the  treatment  with  an  emetic.  I  use 
the  acetous  tincture  of  Lobelia  and  Sanguinaria,  and  give  it  so 
as  to  obtain  a  prompt  and  thorough  action.  It  should  relieve 
the  depression  of  the  nervous  system,  and  produce  a  free  and 
equal  circulation  of  blood.  If  the  eruption  should  not  appear  at 
the  usual  time,  the  symptoms  becoming  grave  as  named,  T  should 
also  use  the  emetic,  as  I  would  if  there  was  a  retrocession  of  the 
eruption. 

In  this,  as  well  as  the  other  forms  of  scarlatina,  in  some  cases, 
I  prefer  fatty  inunction  to  the  use  of  the  bath.  It  relieves  the 
irritation  of  the  skin,  keeps  it  soft,  and  thus  favors  some  se- 
cretion. Many  physicians  direct  their  patients  rubbed  with  a 
bacon  rind.  A  prominent  Homceopath  of  my  acquaintance  places 
much  dependence  upon  it.  Instead  of  this  I  use  lard  alone  in 
the  first  forms  of  the  disease,  and  an  ammonia  inunction  (hyd. 
ammonia  5j,  lard  5ij.)  in  the  malignant  form. 

In  congestive  diseases  it  has  been  recommended  to  sponge  the 
surface  with  a  solution  of  carbonate  of  ammonia,  or  liquor  am- 
monia. Several  cases  are  recorded  of  malignant  scarlet  fever, 
purpura  hemorrhagica,  and  typhus  fever,  in  which  it  was  em- 
ployed with  advantage.  In  using  it,  one  ounce  of  muriate  of 
ammonia  is  added  to  two  quarts  of  hot  water,  and  applied  freely. 
The  carbonate  may  be  used  in  the  same  proportion  in  diseases 
of  children. 


220  DISEASES  OF  CHILDEEN. 

It  must  not  be  forgotten  that  this,  like  other  diseases,  will 
vary  in  different  years.  In  one  season  fatty  inunction  is  one  of 
our  most  important  means,  and  water  seems  to  exert  an  unpleas- 
ant influence  upon  the  skin.  But  in  another  year,  the  fatty 
matter  can  not  be  used,  for  it  seems  to  close  the  skin  up  and  pre- 
vent excretion,  and  we  are  forced  to  use  soap  and  water  for  its 
removal,  and  afterwards  employ  baths.  I  have  had  most  admi- 
rable results  from  hot  sponge  baths,  as  I  have  had  from  the 
ammonia  just  named. 

I  may  also  ijote  that  tincture  of  muriate  of  iron  has  also  been 
used  in  scarlet  fever  with  advantage.  It  is  given  after  the  erup- 
tion has  made  its  appearance ;  the  combination  with  glycerine  is 
the  best  form,  and  this  may  also  be  used  as  a  gargle.  It  will  also 
be  of  advantage  during  convalescence,  and  will  tend  to  prevent 
dropsy  and  the  other  sequelae. 

The  enlargement  of  the  lymphatic  glands  is  a  source  of  much 
trouble  in  this  form  of  the  disease,  appearing  frequently  when 
the  patient  is  apparently  convalescent.  I  prefer  an  application 
of  the  Salicylic  Acid  and  Borax  aa.  Sss.,  to  water  Oj.,  or  some- 
times double  this  strength.  If  it  becomes  evident  that  suppura- 
tion will  occur,  no  benefit  will  follow  from  trying  to  keep  it 
back;  indeed  we  would  thus  endanger  diffusive  abscess.  To 
hasten  suppuration,  we  apply  a  poultice  of  a  decoction  of  cornus, 
thickened  with  wheat  bran  or  powdered  ulmus,  or  of  equal  parts 
of  hydrastis  and  elm. 

It  is  well  to  continue  the  use  of  the  salicylic  acid  solution 
with  the  poultices,  as  a  preventive  against  diffusive  abscesses  and 
purulent  absorption.  And  should  there  be  symptoms  indicating 
this  result,  put  the  patient  upon  the  use  of  sulphite  of  soda,  and 
give  quinine  and  iron,  with  stimulants,  if  needed,  and  a  nutri- 
tious diet. 

If  the  lymphatic  inflammation  goes  on  to  suppurotian,  it  is 
well  to  open  the  abscess  early,  and  not  let  the  pus  burrow  in  the 
tissue.  This  not  only  relieves  pain,  but  it  lessens  the  danger  of 
secondary  abscesses. 

The  first  intimation  of  dropsy  should  be  noticed,  and  appro- 
priate treatment  adopted.  Usually  we  will  note  its  appearance 
in  a  swelling  of  the  upper  eyelids,  and  sometimes  in  a  night  the 
eyes  will  be  closed.  CEdema  of  the  feet  is  also  common,  and  in 
either  case  albumen  will  probably  be  found  in  the  urine.     In  the 


PERTUSSIS.  221 

majority  of  cases  Apocynum,  with  the  small  dose  of  Aconite,  will 
be  the  remedy.  If  not,  we  will  probably  choose  between  Aralia 
and  sulphate  of  manganese. 

PERTUSSIS-WHOOPINa-COUGH. 

This  is  eminently  a  contagious  affection,  though  how  it  is 
propagated  is  more  than  is  known.  Usually  it  is  contracted  only 
when  children  are  brought  in  such  immediate  proximity  that  the 
breath  or  exhalations  of  the  diseased  person  are  inhaled ;  this, 
however,  is  not  always  the  case,  as  the  poison  seems  to  contami- 
nate the  atmosphere,  so  that  persons  take  it  when  at  considerable 
distance  from  those  having  it. 

It  is  undoubtedly  a  disease  of  the  nervous  system,  the  parts 
implicated  being  the  pneumogastric  nerve  and  medulla  oblongata 
at  its  origin.  And  yet,  post-mortem  examination  has  not  shown 
any  more  serious  lesion  of  the  medulla  than  evidence  of  deter- 
mination of  blood,  which  we  would  be  likely  to  find  in  any  case 
of  such  prolonged  irritation  of  the  parts  to  which  the  nerve  is 
distributed.  Like  other  contagious  diseases,  it  runs  a  very  regu- 
lar course,  and  gives  immunity  against  a  subsequent  attack. 

Symptoms. — Whooping-cough  manifests  itself  at  first  as  a 
simple  catarrh,  the  cough  being  gradually  developed.  Some 
days  elapse  before  there  is  anything  distinctive  in  it ;  and  it  is 
not  usually  well  marked  under  from  two  to  four  weeks.  The 
cough  differs  from  others  in  that  it  seems  to  arise  from  an  ob- 
struction to  respiration,  and  forcible  inspiration  is  taken,  and 
then  there  is  a  series  of  short  expulsions  until  the  air  is  all  ex- 
pelled. The  tendency  to  cough  still  continuing,  produces  great 
distress,  and  more  or  less  evidences  of  impaired  respiration  are 
noticed.  The  whoop  is  developed  when  the  cough  becomes  in- 
tense, and  is  the  shrill  sound  formed  as  the  air  is  drawn  through 
the  yet  contracted  larynx  in  the  forcible  inspiration  succeeding 
the  cough.  The  cough  is  paroxysmal,  the  paroxysms  recurring 
at  longer  or  shorter  intervals,  in  proportion  to  the  severity  of 
the  disease. 

There  is  a  secretion  of  glairy  mucus  in  most  cases,  which  is 
raised  at  the  latter  part  of  the  cough,  and  frequently  seems  to 
increase  the  suffering.  If  the  disease  is  very  severe,  and  some- 
times when  mild,  there  is  a  free  yellowish  expectoration.     There 


222  DISEASES   OF  CHILDREN. 

is  frequently  some  fever  at  the  commencement  of  the  disease,  and 
it  may  occur  during  its  progress. 

Writers  divide  pertussis  into  three  stages  :  the  first,  lasting 
from  five  to  fifteen  days,  presents  the  symptoms  of  ordinary  ca- 
tarrh ;  the  second,  lasting  from  three  to  six  weeks,  presents  the 
peculiar  whoop,  which  gives  name  to  the  cough ;  and  the  third, 
of  variable  duration,  is  the  period  of  decline. 

It  is  during  the  second  stage  of  the  disease  that  the  symptoms 
become  so  aggravated  as  to  demand  relief.  We  sometimes  see 
the  paroxysms  of  cough  so  severe  that  the  little  patient  will  turn 
purple  in  the  face,  gasp  for  breath,  and  even  for  some  time  after- 
ward exhibit  marked  evidences  of  imperfect  respiration.  Occa- 
sionally bronchitis  sets  in  and  is  very  troublesome ;  sometimes 
there  is  marked  congestion  of  the  lungs ;  at  others,  the  frequent 
and  severe  paroxysms  of  coughing  prevent  necessary  rest,  derange 
the  functions  of  the  body,  and  wear  the  patient  out. 

In  some  cases  there  is  a  tendency  in  the  disease  to  recur  for 
months  after  it  has  ceased,  on  exposure  to  cold,  though  almost 
always  in  a  mild  form.  Instead  of  impairing  the  strength  of  the 
lungs  in  feeble  children,  it  seems  rather  to  have  increased  it,  and 
may  sometimes  be  regarded  as  of  marked  advantage  to  the  child. 

Diagnosis. — In  the  first  stage  it  is  with  difficulty  recognized, 
but  in  the  second,  the  paroxysmal  character  of  the  cough,  its 
long  continuance  without  seeming  cause,  and  the  peculiar  whoop, 
are  sufficient  for  the  diagnosis. 

Treatment. — Except  in  some  rare  cases  I  discard  all  of  the 
old  methods  in  the  treatment  of  this  disease,  and  rely  wholly  on 
specific  means.  We  get  a  clear  idea  of  the  variability  of  named 
diseases  in  this  study,  because  it  belongs  to  the  class  of  conta- 
gious diseases,  is  produced  by  a  specific  poison,  and  has  symp- 
toms so  characteristic  that  it  cannot  be  mistaken,  and  to  the  cas- 
ual observer  all  cases  are  alike  except  as  to  severity.  Yet  we 
find  that  it  is  not  always  the  same  disease,  but  varies  from  season 
to  season,  and  the  remedy  that  cures  it  now  may  be  of  no  service 
in  the  next  recurrence  of  the  disease.  If  one  will  but  think,  it 
is  just  the  same  with  other  coughs. 

AVe  have  a  group  of  remedies  for  whooping  cough,  all  of  them 
good,  all  of  them  specific,  if  we  have  the  right  indication.  They 
are  Nitric  Acid,  Belladonna,  Drosera,  Bromide  of  Aramoniuni. 


PAROTITIS.  223 

Nitric  Acid  is  an  old  remedy,  and  a  very  good  one,  but  will 
not  benefit  all  cases  of  whooping  cough — which  are  the  cases? 
If  the  tongue  has  a  violet  color,  showing  over  red,  the  remedy 
will  cure  whooping  cough,  as  it  would  cure  ague,  or  any  other 
curable  disease,  with  the  same  symptom. 

Belladonna  is  also  an  old  remedy,  and  a  most  excellent  one, 
but  it  would  not  relieve  the  nitric  acid  cases.  What  cases  will 
it  cure  ?  When  the  patient  is  dull  and  inclined  to  sleep,  (the 
eyes  are  dull,  the  pupils  dilated,)  just  as  it  is  the  remedy  in  other 
diseases  showing  these  symptoms. 

Drosera  is  the  remedy  for  the  cough  of  measles.  There  is 
something  peculiar  about  this  cough  which  will  be  readily  rec- 
ognized, and  it  is  based  upon  a  peculiar  catarrhal  condition  of 
the  raucous  membranes.  Whooping-cough  may  show  these  very 
conditions,  and  if  so,  Drosera  is  the  remedy. 

Bromide  of  Ammonium  is  peculiarly  the  epileptic  remedy,  and 
if  our  whooping-cough  shows  the  peculiar  convulsive  condition, 
we  expect  to  relieve  with  this  agent. 

What  may  we  say  then  ?  Why  certainly  that  we  have  four 
classes  of  whooping-coughs,  distinct  and  separate,  and  which 
may  be  diagnosed,  and  the  right  remedy  selected. 

PAROTITIS. 

Parotitis,  or  mumps,  belongs  to  the  class  of  diseases  we  have 
been  studying,  as  it  is  caused  by  a  specific  contagion,  generated 
during  the  progress  of  the  disease,  propagated  by  contact,  and 
when  a  person  has  had  the  disease  there  is  subsequent  immunity. 

In  the  case  of  small-pox  the  contagious  material  is  something 
tangible ;  in  scarlatina  and  rubeola  there  is  a  distinctive  disease 
of  the  skin,  and  may  be  such  change  that  it  is  propagated  by  the 
epidermis  thrown  oiF,  or  by  the  excreta  in  breath,  from  skin, 
kidneys  and  bowels.  But  in  whooping-cough  and  in  mumps  we 
do  not  know  the  character  of  the  contagion,  or  why  in  the  one 
case  it  should  involve  the  medulla  oblongata,  and  in  the  other 
case  the  parotid  glands. 

Pathology. — Arising  from  a  specific  contagion,  to  which  the 
patient  has  been  exposed,  usually  by  contact,  we  find  the  disease 
manifesting  itself  in  a  peculiar  inflammation  of  the  parotid  gland. 
I  say  peculiar,  because  there  is  but   little  exudation  of  plastic 


224  DISEASES  OF    CHILDREN. 

material,  and  but  little  tendency  to  suppuration.  In  some  cases, 
indeed,  it  seems  but  little  more  than  an  irrigation  with  marked 
determination  of  blood,  with  some  watery  or  serous  effusion  into 
the  tissues.  In  other  cases  the  inflammatory  symptoms  are  all 
well  developed,  and  the  function  of  the  gland  entirely  suspended. 
Other  glandular  tissues  may  be  involved.  Thus  we  have  a  me- 
tastasis of  the  disease  to  the  testes  in  the  male,  and  to  the  mam- 
mary glands  in  the  female,  and  I  have  noticed  disease  of  the 
thyroid,  and  I  think  of  the  thymus  bodies. 

Symptoms. — The  period  of  incubation  varies  from  five  to 
twelve  days,  during  which  the  person  has  no  symptom  of  the 
coming  trouble.  Frequently  he  will  go  to  bed  well,  and  awake 
with  swelling  about  the  jaws  and  ears,  stiffness  of  the  neck,  and 
when  he  sits  down  to  his  breakfast  will  find  both  mastication 
and  deglutition  difficult.  Acids  increase  the  pain,  and  a  very 
common  domestic  means  of  diagnosis  is  to  have  the  patient  try 
to  eat  a  pickle,  when  the  sharp  pain  about  the  articulation  of  the 
jaw  soon  tells  the  story. 

In  some  cases  the  disease  will  be  ushered  in  with  headache  and 
pains  in  the  back  and  extremities,  a  well  marked  chill,  followed 
by  febrile  reaction.  In  these  cases  the  inflammatory  action  runs 
high  and  the  pain  in  and  about  the  parotid  space  and  ear  is  ex- 
quisite, and  the  patient  can  hardly  eat  or  speak  because  it  in- 
creases it.  The  fever  will  continue  one  or  two  days,  and  then 
pass  away  with  increased  excretion,  but  the  parotial  inflamma- 
tion and  swelling  will  continue  for  five  or  six  days,  and  then 
slowly  pass  away. 

But  one  side  may  be  involved  in  the  attack,  and  it  is  thus 
claimed  that  the  person  may  contract  the  disease  again  on  subse- 
quent exposure,  the  other  parotid  being  involved. 

When  there  is  a  metastasis  to  the  testes,  the  patient  feels  a 
deep  aching  dragging  pain,  with  occasional  lancinating  pains 
through  the  organ.  The  slightest  touch  or  pressure  occasions 
exquisite  pain.  The  testicle  is  found  greatly  swollen  and  red- 
dened; very  rarely  both  are  affected  at  a  time,  but  occasionally 
one  is  involved,  and' as  the  acute  symptoms  subside,  the  other 
testicle  swells  and  becomes  tender.  In  these  cases  the  fever  is 
likely  to  recur,  and  the  secretions  are  arrested. 

Mastitis  is  not  so  common,  yet  I  have  seen  cases  in  which  the 
breast  was  very  sensitive  and  painful.     The  thyroid  enlargement 


SCROFULA.  225 

is  associated  with  ovarian  irritation  iu  the  woman  after  puberty, 
and  may  continue  for  some  months. 

Treatment. — The  patient  is  put  upon  the  use  of  Aconite  or 
Veratrum,  as  indicated,  with  Phytolacca  as  the  specific  remedy 
in  the  larger  number  of  cases.  A  very  common  prescription  is, 
^  Tinct.  Aconite  gtt.  v.,  Tinct.  Phytolacca  gtt.  x.,  water  5iv.; 
a  teaspoonful  every  hour.  Belladonna  replaces  the  Phytolacca, 
if  there  is  dullness  and  stupor  ;  Rhus,  if  there  is  sharp  pain, 
frontal  headache,  and  sharp  pulse;  Gelseminum,  if  there  is  in- 
creased heat  of  the  head,  inability  to  sleep,  with  general  head- 
ache. In  some  cases  there  is  a  clear  indication  for  sulphurous 
acid  in  the  red  tongue,  with  nasty  glutinous  coating;  and  in 
others  the  indication  is  equally  clear  for  sulphite  of  soda. 

I  do  not  think  it  best  to  make  local  applications  to  the  swol- 
len parotids — a  flannel  cloth  tied  around  the  head  to  insure 
warmth  being  sufficient.  Still,  if  the  pain  is  very  severe,  a  lotion 
of — I^  Tinct.  Aconite  5j.  Tinct.  Phytolacca  Sj.,  water  5j.,  i^^^y 
be  applied  every  two  or  three  hours.  Sometimes  a  flannel  cloth 
wrung  out  of  hot  water,  and  applied  for  a  few  hours,  will  give 
relief. 

If  there  is  a  metastasis  to  the  testes,  they  should  be  well  sup- 
ported with  a  flannel  bandage,  and  in  some  cases  the  lotion  of 
Aconite  and  Phytolacca  may  be  used,  and  in  others  of  Bella- 
donna and  Phytolacca.  *In  older  persons,  if  the  swelling  per- 
sists, we  strap  the  swollen  testicle  firmly  to  the  abdominal  wall, 
using  adhesive  plaster. 

SCROFULA. 

Scrofula,  or  king's  evil,  is  one  of  the  most  common  diseases  the 
physician  has  to  treat ;  and  manifesting  itself  in  so  many  differ- 
ent forms,  its  symptoms  are  protean,  and  its  treatment  varied 
and  difficult.  It  is  undoubtedly  a  disease  of  the  blood,  though 
the  secretions  and  nervous  system  are  markedly  affected.  Cope- 
land  remarks  that "  The  blood  in  scrofula  and  tubercles  has  long 
been  considered  popularly,  and  with  much  truth,  to  be  of  a 
poorer  quality  than  in  healthy  constitutions."  Simon  states 
that  the  blood  is  deficient  in  solid  constituents,  especially  in 
fibrin  and  in  corpuscles.  According  to  Duboise,  the  blood  of 
scrofulous  subjects  coagulates  slowly,  the  clot  is  small,  soft,  and 

diffluent ;  the  serum  is  thin,  and  often  of  a  reddish  color.     Under 
15 


226  DISEASES  OF   CHILDREN. 

the  microscope,  some  of  the  corpuscles  appear  devoid  of  color  at 
the  edges  only,  some  entirely  colorless.  Their  size  is  not  mate- 
rially changed,  but  they  appear  flattened,  spherical,  or  cylindri- 
cal. Hence  he  infers  that  there  is  a  deficiency  of  the  salts  in 
the  blood  of  scrofulous  persons.  Mr.  Phillips  remarks  that,  in 
every  case  in  which  he  examined  the  blood  of  scrofulous  subjects, 
the  coagulum  was  relatively  small,  the  serum  large,  the  clot  un- 
usually soft,  almost  diffluent ;  in  a  few  instances  only,  it  was  tol- 
erably firm.  In  most  cases  the  proportion  of  globules  was  con- 
siderably under  the  healthy  standard.  The  fibrin  had  not  gen- 
erally undergone  much  change.  The  causes  of  scrofula,  whether 
those  acting  on  the  parent,  or  the  individual  himself  at  a  very 
early  age,  or  even  at  later  periods,  whether  external  or  internal, 
whether  hereditary,  congenital,  or  acquired,  have  all  a  similar 
tendency,  namely,  directly  to  depress,  or  to  exhaust  organic  ner- 
vous, or  vital  power  ;  and  thereby  to  impair  vital  resistance,  to 
prevent  the  processes  of  repair  consequent  upon  morbid  vascular 
action,  and  to  arrest  the  formative  or  organizing  tendency  of  the 
exudations  produced  by  this  action.  Not  only  is  there  a  dispo- 
sition to  a  dyscrasia — to  a  solution  of  vital  cohesion,  observable 
in  parts  near  the  seat  of  scrofulosis,  but  there  is  also  an  absence 
of  the  formative  effort  in  the  fluids  exuded  by  morbid  actions  in 
scrofulous  constitutions.  The  state  of  vital  power  or  endowment 
in  the  several  tissues  or  organs  of  scrofulous  persons,  appears  in- 
sufiicient  both  for  the  healthy  or  sthenic  actions  or  functions 
these  parts  should  perform,  and  for  the  organization  of  the  fluids 
or  matters  effused  from  their  vessels.  Hence  the  changes  which 
the  exuded  matters  undergo  neither  favor  nor  are  followed  by 
organization,  even  in  its  lowest  grades; 'and  most  probably,  the 
fluid  itself  is  exuded  from  the  capillaries  of  a  kind  and  in  a  state 
which  indisposes  it  to  organization. 

Scrofula  is  said  to  be  hereditary,  and  so  it  is  in  this,  that  the 
child  inherits  a  defective  vitality,  which  manifests  itself  in  im- 
perfect elaboration  of  the  blood,  and  enfeebled  vitality  of  tissues 
and  organs.  Such  persons  may  live  for  years  without  any  man- 
ifestations of  the  disease,  simply  because  there  has  been  no  cause 
acting  to  further  depress  vitality,  or  to  determine  scrofulous  de- 
posit. Finally,  however,  from  arrest  of  secretion  or  other  cause, 
the  system  is  depressed,  and  an  irritation  of  some  part  being  set 
up  at  the  same  time,  Ave  have  full  manifestation  of  the  disease. 

If  we  have  correctly  stated  the  pathology  of  the  disease,  what 


SCROFULA.  227 

measures  may  be  adopted  to  remove  this  predisposition  ?  Some 
contend  that  it  can  not  be  removed,  but  we  have  evidence  suffi- 
cient to  show  that  it  can  be  entirely  eradicated.  To  accomplish 
this  we  resort  principally  to  hygienic  measures,  such  as  will  stim- 
ulate healthy  digestion,  secretion,  and  innervation.  Remove  the 
child  to  the  country,  let  it  have  plenty  of  out-door  exercise  with 
accompanying  light  and  sunshine,  give  it  nutritious  food  and  es- 
chew condiments,  pastry,  and  sweetmeats,  and  the  entire  consti- 
tution of  the  child  will  undergo  a  change. 

Scrofula  manifests  itself  in  various  ways  ,•  very  frequently  the 
deposit  commences  in  the  lymphatic  glands ;  sometimes  in  the 
viscera,  as  of  the  lungs,  liver,  brain,  etc.;  again  in  the  bones,  in 
the  muscles,  in  the  skin,  in  fact  in  all  the  tissues  of  the  body. 
The  determining  cause  of  the  deposit  is  undoubtedly  an  irrita- 
tation  of  the  part,  causing  determination  of  blood. 

Symptoms. — The  symptoms  of  a  scrofulous  constitution  are 
not  well  marked,- though  it  has  been  frequently  described  as  if 
they  were.  It  is  true  that  it  occurs  most  frequently  in  children 
of  fair  skin,  blue  eyes,  light  hair,  and  regular  features ;  but  it  is 
so  often  met  with  in  persons  of  dark  skin,  hair  and  eyes,  irregu- 
lar features,  and  rough  development,  that  it  is  impossible  to  say, 
by  a  child's  appearance,  whether  it  is  scrofulous  or  not.  There 
is,  however,  in  very  many  cases,  such  manifest  imperfections  in 
assimilation,  circulation,  and  nutrition,  and  feeble  vitality,  that 
we  are  enabled  to  recognize  the  scrofulous  constitution.  Usu- 
ally, the  previous  history  of  the  family  will  throw  some  light  on 
the  matter;  but,  as  Prof.  Powell  has  well  demonstrated,  the 
scrofulous  constitution  may  be  and  often  is  developed  in  children 
by  incompatibility  of  the  parents. 

Scrofula  manifests  itself  when,  from  any  cause,  the  vitality  of 
the  system  is  so  depressed  that  the  blood  is  not  properly  elabo- 
rated, or  the  detritus  of  the  system  is  not  removed,  either  by  an 
imperfection  in  the  process  of  retrograde  metamorphosis,  or  by 
failure  of  the  excretory  organs.  The  situation  is  determined  in 
all  cases  by  the  existence  of  a  local  irritation  or  inflammation  in 
or  adjacent  to  the  parts  affected.  Thus,  we  observe  scrofulous 
deposit  and  disease  of  the  cervical  lymphatic  glands,  from  disease 
or  irritation  of  the  mouth  or  throat;  involvement  of  the  axillary 
glands,  from  disease  of  the  arm  or  breast;  of  the  inguinal  glands 
from  disease  of  the  lower  extremities  or  genital  organs;  of  the 


228  DISEASES   OF   CHILDREN. 

mesenteric  glands,  from  disease  of  the  bowels ;  of  the  lungs, 
from  irritation  produced  by  cold ;  and  in  the  muscles  and  bones, 
faom  the  same  cause.  It  might  be  divided  into  two  forms,  as  it 
occurs  in  the  lymphatic  glands,  or  as  a  deposit  in  the  form  of 
tubercles  in  the  structure  of  a  part,  but  no  practical  benefit  would 
grow  out  of  such  distinction.  As  we  have,  in  other  places,  de- 
scribed scrofulous  or  tubercular  affections  of  the  principal  organs, 
we  will  confine  ourselves  here  to  a  description  of  it  as  it  affects 
the  lymphatic  glands. 

In  many  cases  the  irritation  giving  rise  to  the  development  of 
scrofula  is  very  manifest,  and  occasionally  demands  treatment, 
but  in  others  it  is  very  slight.  The  superficial  lymphatic  glands 
are  then  observed  to  become  slightly  enlarged  and  hard,  so  as  to 
be  very  perceptible  when  the  finger  is  passed  over  them.  This 
occurs  frequently  in  scrofulous  children  in  the  superficial  cervical 
glands,  without  further  development,  and  is  considered  by 
many  as  the  best  indication  of  a  scrofulous  constitution.  When 
the  disease  has  fully  commenced,  one  or  more  of  the  glands  con- 
tinue to  enlarge,  a  low  form  of  inflammation  sets  in,  and  deposit 
takes  place  in  the  adjacent  tissues,  which  become  swollen  and 
hard.  Now  the  inflammation  becomes  more  or  less  acute,  the 
part  is  reddened,  painful,  hot,  tender  on  pressure,  and  the  swell- 
ing increases  rapidly.  Continuing  in  this  way  for  a  longer  or 
shorter  time,  suppuration  commences,  and  the  deposit  is  gradu- 
ally changed  into  pus,  which  in  time  makes  its  way  to  the  sur- 
face,  and  is  discharged.  This  occupies  a  variable  period  of  time, 
sometimes  passing  through  all  its  stages  in  eight  or  ten  days,  and 
at  others  occupying  as  many  weeks.  In  some  cases  the  inflam- 
mation is  acute  and  the  pain  severe,  but  in  others  it  progresses 
without  much  redness,  heat,  or  pain. 

The  pus  forms  slowly  in  many  cases,  and  there  is  but  little 
tendency  to  its  discharge,  and  in  others  weeks  pass  over,  the  part 
still  continuing  hard  ;  and  at  last,  when  our  patience  is  nearly 
exhausted,  suppuration  occurs  rapidly.  Sometimes  the  pus  is 
well  formed  and  healthy,  and  when  discharged  the  part  heals 
readily;  but  at  others  it  is  watery,  of  a  greenish-brown  color,  or 
clear,  with  more  or  less  flocculent  material  mixed  with  it.  Occa- 
sionally the  abscess  exhibits  no  tendency  to  point,  but  the  pus 
burrows  in  the  tissues  for  a  long  time,  unless  it  is  opened.  In 
other  cases,  when  the  pus  is  discharged  the  abscess  does  not  heal, 
but  continues  to  discharge  a  dirty,  flocculent  pus;  and  if  we  ex- 


SCEOFULA.  229 

amine  it,  we  will  find  the  walls  ragged,  and  often  a  chain  of  lym- 
phatic glands  dissected  out,  and  lying  at  the  bottom. 

The  constitutional  disturbance  varies  greatly.  Sometimes 
there  is  quite  brisk  febrile  action  when  inflammation  first  comes 
up,  with  loss  of  appetite,  arrest  of  secretion,  and  much  prostra- 
tion. In  these  cases,  suppuration  is  frequently  marked  with  a 
chill  or  rigor,  and  occasionally  attended  with  hectic  fever  and 
night-sweats.  In  other  cases,  there  is  no  constitutional  disturb- 
ance further  than  loss  of  strength,  and  some  derangement  of  se- 
cretion, languor,  and  a  peculiar  pallid  appearance  of  the  surface. 

Diagnosis. — Scrofulous  enlargement  is  readily  recognized  from 
its  situation,  and  from  the  attendant  symptoms  above  named. 

Prognosis. — In  very  many  cases  the  prognosis  will  be  favor- 
able, as  the  tendency  to  the  disease  is  not  so  strong  but  that  it 
may  be  removed  by  appropriate  treatment,  and  measures  calcu- 
lated to  improve  the  general  health.  There  is  no  doubt  but  that 
by  proper  care  the  constitution  of  a  child  can  be  so  entirely 
changed,  in  the  course  of  time,  that  the  tendency  to  this  disease 
will  be  entirely  removed.  There  are  other  cases,  however,  iu 
which,  though  we  may  get  the  patients  safely  through  the  present 
attack,  they  will  inevitably  die,  sooner  or  later,  of  this  or  some 
analogous  aiFection. 

Treatment. — When  children  are  predisposed  to  scrofula, 
a  judicious  hygienic  plan  should  be  adopted  to  strengthen  the 
constitution,  by  improving  the  functions  of  digestion,  assimila- 
tion and  nutrition.  Such  children  are  said  to  be  tender,  and 
hence  they  are  kept  in  the  house  a  considerable  part  of  the  time 
for  fear  of  colds  and  sickness,  and  being  weakly  they  are  petted, 
and  their  appetites  pampered;  and  not  spending  their  time  in 
play,  as  they  should  do,  their  minds  are  precociously  developed 
at  the  expense  of  their  bodies.  Instead  of  this,  such  children 
should  be  accustomed  to  the  open  air  from  an  early  age.  As  with 
plants,  the  human  species  can  not  be  robust  and  stout  without 
fresh  air  and  sunshine.  As  soon  as  they  commence  walking 
they  should  play  in  the  open  air  whenever  the  weather  is  suitable. 
In  this  way,  the  constitution  is  strengthened,  and  the  liability 
to  colds  by  alternations  of  temperature  much  reduced.  Sleeping- 
rooms  should  in  all  cases  be  large,  well-ventilated,  and  exposed 
to  the  direct  rays  of  the  sun  during  some  portions  of  the  day. 


230  DISEASES  OF  CHILDREN. 

Up  to  the  age  of  eight  or  ten  years,  the  child's  occupation  should 
be  out  of  doors,  and  whether  it  was  play  or  work,  it  should  be 
of  such  a  character  as  to  bring  into  action  all  the  muscles  of  the 
body.  Before  this  age  the  child  should  not  be  required  to  study, 
neither  should  it  be  sent  to  school,  there  being  sufficient  time 
after  this  for  all  laudable  educational  purposes.  Regular  meals 
of  good,  hearty  food,  with  fruits  in  their  season,  with  a  sedulous 
avoidance  of  all  cakes,  sweetmeats,  etc.,  are  of  the  highest  im- 
portance. An  observance  of  these  rules,  the  children  being  raised 
in  the  country,  will  almost  invariably  result  in  a  complete  change 
of  constitution,  and  such  increased  vitality  that  not  only  is  the 
predisposition  to  this  disease  removed,  but  the  child  becomes  a 
vigorous,  hearty  man  or  woman,  instead  of  dropping  into  a 
premature  grave  from  phthisis  or  some  kindred  aifection. 

In  the  treatment  of  the  disease,  the  indications  are  to,  first, 
improve  the  quality  of  the  blood,  and  raise  it  above  the  point  at 
which  scrofulous  material  is  effused,  and,  second,  to  promote  the 
absorption  and  elimination  of  such  material  as  may  have  been 
deposited.  To  accomplish  these  indications  various  means  are 
resorted  to,  according  to  the  condition  of  the  patient.  Altera- 
tives are  relied  upon  to  a  very  great  extent,  and  various 
agents  of  this  class  are  employed.  By  some  the  compound 
syrup  of  Stillingia  and  iodide  of  potassium  are  considered  the 
preferable  agents,  and  are  used  to  a  very  great  extent.  My  ex- 
perience has  not  been  favorable  to  these  remedies,  and  I  have 
been  compelled  to  select  others.  I  now  use  the  Phytolacca, 
Rumex  Crispus,  Alnus  Serrulata,  Iris,  Scrophularia,  Podophyl- 
lum, Corydalis,  and  some  two  or  three  other  agents,  sometimes 
singly,  or  two  or  three  combined  to  suit  the  indications  of  the 
case.  Acetate  of  potash  or  other  saline  diuretic  is  my  main 
dependence  to  promote  absorption  and  elimination  by  the  kid- 
neys. I  believe  it  to  be  as  much  more  efficient  than  iodide  of 
potassium,  as  this  is  over  epsom  salts  ;  at  the  same  time  employ- 
ing the  bitter  tonics,  iron,  the  hypophosphites,  and  cod-liver  oil. 

Very  much  depends  upon  getting  proper  action  of  the  three 
principal  emunctories — the  skin,  kidneys,  and  bowels.  Great 
care  is  necessary,  however,  in  the  severer  cases,  not  to  overstimu- 
late  and  exhaust  these  organs.  To  restore  the  secretion  of  the 
skin,  I  employ — if  it  is  dry  and  husky — oleaginous  frictions, 
followed  by  thorough  washing  with  castile  soap  and  water ;  if 
soft,  relaxed,  and  flabby,  I  use  the  bitter  tonic  baths ;  if  there  is 


SCROFULA.  231 

deficient  capillary  circulation,  with  coldness  of  the  extremities,  a 
sponge-bath  of  dilute  Tinct.  of  Capsicum. 

As  a  local  application  to  promote  resolution,  I  have  used  equal 
parts  of  tinctures  of  Belladonna  and  Stramonium,  and  glycerine, 
or  if  there  is  much  fever,  an  equal  part  of  tincture  of  Aconite. 
In  other  cases,  a  wash  of  equal  parts  of  tincture  of  muriate  of 
iron  and  glycerine  may  be  used,  or  the  part  may  be  painted  with 
the  iron,  and  then  followed  by  the  lotion  named.  In  some  cases 
we  obtain  good  results  from  the  use  of  the  Mayer's  ointment  or 
the  black  salve.  Finely  pulverized  Indian  turnip,  made  into  a 
poultice,  is  an  excellent  application.  If  there  is  much  heat  and 
redness,  we  may  use  fomentations  of  Stramonium  leaves,  or  a 
poultice  of  a  decoction  of  Cornus  and  wheat-bran.  If  it  is  seen 
that  resolution  can  not  be  effected,  we  will  employ  poultices  to 
facilitate  suppuration,  and  if  pus  has  formed  to  any  extent,  in- 
stead of  permitting  it  to  burrow,  we  will  immediately  open  the 
abscess.  The  poultice  may  be  continued  for  a  few  days  longer, 
until  the  inflammation  has  passed  off,  when  it  may  be  dressed 
with  Mayer's  ointment,  or  other  stimulant  application,  until  it 
heals.  If  it  does  not  discharge  well,  and  looks  ragged,  it  will 
be  best  to  use  a  solution  of  sesquicarbonate  of  potash  until  sup- 
puration becomes  free.  And  in  those  cases  in  which  the  healing 
process  is  slow,  and  the  discharge  thin  and  watery,  it  may  also 
be  employed  with  advantage. 

In  some  cases  the  healing  process  progresses  until  the  abscess 
is  nearly  closed,  but  a  red,  ugly  cicatrix  is  left,  from  which  there 
is  more  or  less  oozing;  or,  if  it  closes,  it  breaks  out  frequently, 
and,  after  running  for  a  few  days,  again  closes,  with  a  thin,  blu- 
ish cicatrix.  These  cases  are  remarkably  tedious,  and  are  very 
difficult  to  cure.  I  have  treated  them  by  employing  the  zinc 
paste  to  entirely  destroy  the  morbid  cicatrix,  and  then  healing 
with  some  mild  stimulating  ointment;  or,  instead  of  this,  we  may 
sometimes  dissect  the  cicatrix  out,  and  draw  the  parts  together 
with  adhesive  straps.  In  other  cases  we  will  find  that  a  decoc- 
tion of  equal  parts  of  Cornus,  Rumex,  and  Alnus,  continually 
applied,  and  taken  internally,  will  in  time  overcome  the  disease. 


232  DISEASES  OF    CHILDEEN. 

DYSCRASIAS. 

The  definition  of  dyscrasia  by  Duuglison,  "  a  bad  habit  of 
body"  would  answer  our  purpose  very  well  as  describing  a  bad 
blood  and  an  impairment  of  nutrition,  and  from  this  enfeebled 
tissues.  The  older  pathologists  used  the  term  to  express  "  an  ill 
habit  or  state  of  the  humors,"  i.  e.,  of  the  fluids  of  the  body. 

It  is  used  to  describe  a  condition  of  life,  and  not  a  special  form 
of  diseased  action,  though  whatever  form  this  may  assume,  it 
possesses  the  characteristics  of  the  entire  group.  In  scrofula  the 
impairment  of  the  blood  manifests  itself  in  the  deposit  of  imper- 
fect albumen,  most  frequently  in  the  neighborhood  of  lymphatic 
glands.  In  this  the  nutritive  fluids  are  impaired,  and  the  tissues 
formed  from  them  are  also  imperfect.  In  addition  to  this  the 
excretory  organs  being  insufficient  for  its  removal,  we  have  it 
thrown  off"  in  the  skin,  producing  skin  diseases ;  in  cellular 
tissue,  producing  low  grades  of  inflammation,  and  in  other  tissues 
giving  rise  to  degenerations  and  inflammatory  afifections. 

Causes. — The  causes  giving  rise  to  this  condition  are  numer- 
ous ;  indeed  whatever  depresses  the  vital  powers,  either  an  im- 
pairment of  digestion  and  assimilation,  or  retrograde  metamor- 
phosis and  excretion,  will  produce  it.  Hereditary  feebleness  of 
vitality  or  formative  power  is  very  frequently  the  cause.  Add 
to  this  imperfect  food,  deficient  ventilation,  impure  air,  want  of 
sunshine  and  exercise,  and  we  have  the  common  causes. 

We  have  also  to  take  into  consideration  the  fact  that  bad  blood 
or  bad  tissue  manifests  a  constant  tendency  to  reproduce  itself — 
indeed,  that  whenever  a  fluid  or  tissue  has  had  its  vitality  thus 
impaired,  it  perpetuates  the  impairment ;  also,  that  every  point 
where  the  disease  manifests  itself  becomes,  to  a  greater  or  less 
extent,  a  depot  of  supply  or  depravation.  Thus  the  fluids  are 
being  constantly  impaired  by  materials  taken  into  them  from 
these  sources. 

In  some  of  these  cases,  the  lymphatics  suffer  more  than  other 
parts,  an:l  the  lymph  being  impaired,  the  blood  which  is  formed 
from  it  is  impaired  to  the  same  extent. 

Symptoms. — The  evidence  of  bad  blood  and  bad  tissue  may 
be  foinid  in  the  general  impairment  of  function,  as  well  as  in  the 
many  local  diseases  arising  from  it.     Nutrition   being  imperfect. 


DYSCRASIAS.  233 

the  tissues  are  soft,  and  have  lost  their  tone  and  elasticity  ;  the 
circulation  is  feeble  and  unequal ;  the  appetite  is  variable,  and 
the  digestive  act  imperfect ;  the  tongue  being  pale,  broad,  and 
frequently  covered  with  a  pasty  white  coat. 

There  is  a  want  of  activity  of  the  excretory  organs.  The  skin 
is  dry,  rough,  and  harsh,  or  soft  and  flabby,  in  neither  case  per- 
forming its  function  well.  The  urine  is  changed,  containing  the 
triple  phosphates  or  urates,  or  at  times  of  low  specific  gravity 
and  deficient  in  urea ;  while  the  bowels  are  irregular,  neither 
acting  well  as  a  digestive  or  an  excretory  apparatus. 

The  local  diseases  vary  in  character,  but  they  are  alike  in 
giving  rise  to  deterioration  of  structure,  low  grades  of  inflam- 
mation, a  poor,  purulent  product,  and  deficient  power  of  repair. 

Treatment. — The  indications  for  treatment  are  very  plain  in 
these  cases.  We  have  to  get  rid  of  the  imperfect  blood  and  im- 
perfect tissues,  and  replace  them  with  good  blood  and  good 
tissue.  We  get  rid  of  the  bad  material  by  increasing  the  process 
of  retrograde  metamorphosis,  and  stimulating  the  excretory 
organs — the  skin,  the  kidneys,  and  the  bowels.  We  obtain 
better  blood  and  better  tissue  by  the  use  of  means  that  improve 
the  appetite  and  digestion,  and  that  restore  to  the  blood  the 
materials  in  which  it  is  deficient,  and  which  stimulate  the  nutri- 
tive processes. 

The  selection  of  remedies  to  accomplish  these  objects  is  not 
always  easy.  The  processes  that  we  desire  to  act  upon  are  vital 
processes,  and  remedies  that  increase  their  activity,  if  properly 
used,  may  depress  them,  or  even  arrest  them,  if  used  without  care. 

Excretion,  or  the  removal  of  the  bad  blood  or  tissue  by  the 
skin,  kidneys,  and  bowels,  occupies  the  first  place.  Usually  we 
will  have  no  trouble  in  obtaining  this  influence,  if  we  are  willing 
to  give  time  enough,  and  employ  simple  agents  in  small  doses. 
I  prefer  the  vegetable  alteratives  in  infusion,  singly,  ^or  two  or 
three  in  combination.  The  Alnus,  Rumex,  and  Scrophularia  are 
favorites  of  mine,  and  I  think  they  will  give  satisfaction. 

The  skin  is  reached  by  the  use  of  baths  and  frictions.  If  dry 
and  harsh  I  prefer  fatty  inunction,  with  brisk  friction,  occasion- 
ally using  a  small  portion  of  quinine  in  this  way,  if  there  seems 
need  for  its  tonic  influence  upon  the  nervous  system.  If  relaxed 
and  flabby,  stimulant,  tonic,  or  astringent  baths  are  the  best. 

If  the    bowels   are   inactive,    minute  doses   of    Podophyllin, 


234  DISEASES   OF   CHILDREN. 

thoroughly  triturated  with  sugar,  answer  a  very  good  purpose, 
but  the  doses  should  be  so  small  as  not  to  produce  purgation. 

The  kidneys  are  called  into  action  by  the  use  of  acetate  of 
potash,  better  than  by  other  remedies,  the  solids  of  the  urine 
being  especially  increased.  I  have  regarded  this  as  our  most 
powerful  alterative  with  children,  being  much  better  than  the 
iodides  in  such  common  use. 

While  employing  these  means  the  patient  is  put  upon  the  use 
of  iron,  the  hypophosphites,  cod  oil,  and  the  bitter  tonics.  In 
many  cases  the  tincture  of  muriate  of  iron  with  glycerine,  as 
heretofore  named,  will  answer  the  purpose ;  or  if  a  stomachic  is 
needed,  a  small  portion  of  tincture  of  Nux  vomica  or  solution  of 
strychnine  may  be  added. 

Of  course  a  nutritious  diet,  carefully  adapted  to  the  condition 
of  the  patient  is  indispensable,  and  the  selection  of  this  and  its 
preparation,  will  require  the  advice  of  the  physician.  Add  to 
this  good  ventilation  of  and  siinlight  in  the  sleeping  apartments, 
and  out-door  exercise,  attention  being  paid  to  warmth  and  clean- 
liness, and  we  have  an  excellent  treatment. 

INFANTILE    SYPHILIS. 

A  child  may  receive  the  primary  disease  from  a  chancre  of  the 
breast,  while  nursing,  or  from  a  chancre  of  the  lips  in  the  act  of 
kissing,  or  by  the  use  of  cloths  or  clothing  soiled  by  the  dis- 
charges from  a  chancre.  Though  examples  of  each  of  these  are 
upon  record,  they  are  of  very  rare  occurrence.  In  my  practice  I 
have  seen  one  chancre  of  the  breast,  which,  had  the  woman  been 
nursing,  would  have  communicated  the  disease  to  the  child,  and 
I  have  seen  three  cases  of  chancre  of  the  lip,  in  one  of  which 
such  transmission  occurred. 

In  such  cases,  the  presence  of  the  specific  sore  will  be  sufficient 
for  the  diagnosis,  if  the  physician  gives  it  a  close  examination. 
All  the  symptoms  of  the  primary  disease  will  be  there,  and  after 
a  period  varying  from  two  months  to  a  year,  constitutional 
symptoms  will  be  observed,  if  the  system  becomes  infected. 

But  we  have  a  more  common  source  of  the  syphilitic  lesion, 
in  the  transmission  of  the  disease  from  one  or  the  other  of  the 
parents  to  the  child  in  utero.  This  is  hereditary  syphilis,  and  is 
the  form  we  desire  to  study  particularly. 


INFANTILE  SYPHILIS.  235 

Secondary  syphilis  may  be  transmitted  by  either  parent  to  the 
child,  which  will  be  born  impregnated  by  the  poison.  The  fol- 
lowing are  the  propositions  laid  down  by  M.  Ricord  regarding  its 
transmission,  and  they  may  be  received  as  facts  well  established : 

"  1.  The  father  and  mother  may  transmit  the  disease  to  their 
child  indifferently,  if  either  or  both  of  them  be  affected. 

"  2.  Transmission  may  occur  from  the  parents  to  the  child, 
when  they  are  affected  with  constitutional  symptoms,  or  when  a 
concealed  syphilitic  diathesis  exists  in  them. 

"  3.  The  absence  or  existence  of  constitutional  symptoms  in 
parents  at  the  moment  of  impregnation  and  conception  exerts  no 
influence  on  the  form  of  the  disease,  which  may  afterward  appear 
in  the  child.  The  distinction  established  by  M.  Cazenave  -be- 
tween congenital  and  hereditary  syphilis,  and  which  is  based  on 
the  absence  of  constitutional  symptoms  in  the  parents  at  the 
moment  of  generation,  or  which  have  been  developed  in  the 
mother  during  gestation,  is  totally  erroneous ;  and  indeed  M. 
Cazenave  confesses  that  his  opportunities  of  observing  have  not 
been  ample. 

"  4.  The  character  and  period  of  the  manifestation  of  the 
symptom  in  the  child  are  governed  by  the  stage  to  which  the 
disease  had  advanced  in  the  parents  at  the  moment  of  generation. 
The  treatment  to  which  the  parents  were  subjected  may  also  re- 
tard, prevent,  or  modify  its  appearance  in  the  child. 

"  5.  If  the  parents  are  both  healthy  at  the  time  of  generation, 
and  the  mother  contracts  syphilis  during  gestation,  she  may 
transmit  the  disease  to  her  child.  Of  this  I  have  seen  several 
examples  at  various  periods  of  pregnancy,  even  to  the  seventh 
month  inclusive. 

"  6.  When  the  venereal  poison  is  transmitted  from  the  mother 
to  the  child  during  pregnancy,  infection  takes  place  through  the 
medium  of  the  placenta,  and  in  this  case  appears  to  occur  after 
the  fourth  month  of  utero-gestation. 

"  If  the  father  alone  be  diseased  at  the  moment  of  generation, 
an  abortion  may  occur  at  any  period  of  pregnancy.  If  the 
mother  alone  be  diseased  at  the  time  of  conception,  the  abortion 
will  not  take  place  until  after  the  fourth  month. 

"  7.  Children  born  of  a  father  and  mother  affected  with  syphilis 
may  escape  infection  ;  for  a  certain  disposition  to  receive  con- 
stitutional disease  is  necessary  for  the  child  as  well  as  the  adult, 
and  this  may  be  absent. 


236  DISEASES   OF  CHILDREN. 

"  8.  Observations  made  as  accurately  as  possible  seem  to  prove 
that  constitutional  syphilis  may  be  transmitted  from  the  child  to 
the  mother  during  utero-gestation." 

Symptoms. — The  most  common,  as  well  as  the  most  reliable, 
evidence  of  hereditary  syphilis,  after  the  child  has  attained  the 
age  of  ten  years,  is  the  peculiar  appearance  presented  by  the  per- 
manent teeth,  especially  the  upper  incisors.  These  are  usually 
short  and  narrow,  with  a  broad  vertical  notch  in  their  edges,  and 
their  corners  rounded  off.  Horizontal  notches  or  furrows  are 
often  seen,  but  they  as  a  rule  have  nothing  to  do  with  syphilis. 

Associated  with  this  condition  of  the  teeth,  and  earlier  as  to 
time,  being  noticed  by  the  end  of  the  first  year,  are  the  following 
symptoms  :  "  The  skin  is  almost  always  thick,  pasty,  and  opaque. 
It  often  shows  little  pits  or  scars,  the  relics  of  a  former  eruption, 
and  at  the  angles  of  the  mouth  are  radiating  linear  scars,  run- 
ning out  into  the  cheeks.  The  bridge  of  the  nose  is  almost 
always  broader  than  usual,  and  low  ;  often  it  is  remarkably  sunk 
and  expanded.  The  forehead  is  usually  large  and  protuberant 
in  the  regions  of  the  frontal  eminence  ;  often  there  is  a  well 
marked,  broad  depression  a  little  above  the  eye-brows.  The  hair 
is  usually  thin  and  dry,  and  now  and  then  (but  only  rarely)  the 
nails  are  broken  and  splitting  into  layers.  If  the  eyes  have 
already  suffered,  a  hazy  state  of  the  cornese,  and  a  peculiar  leaden, 
lusterless  condition  of  the  irides,  with  or  without  synechiae,  may 
be  expected.  If,  however,  the  eyes  have  not  yet  been  attacked 
by  a  syphilitic  inflammation,  they  will  present  no  deviation  from 
the  state  of  perfect  health  and  brilliancy. 

"  The  occurrence  of  well  characterized  intestinal  keratitis  is 
now  considered  by  several  high  authorities  as  pathognomonic  of 
inherited  taint.  It  is  also  invariably  coincident  with  the  syphi- 
litic type  of  teeth;  and  when  the  two  conditions  are  found  to- 
gether in  the  same  individual,  I  should  certainly  feel  that  the 
diagnosis  was  beyond  doubt." — Hutchinson. 

The  symptoms  present  at  birth  or  occurring  during  infancy 
vary  in  different  cases.  In  some  cases  the  child  is  born  shriveled 
and  emaciated,  the  skin  hanging  in  folds  in  different  parts  of  the 
body.  The  throat  is  sore,  the  voice  rough  and  unnatural,  and 
an  unnatural  discharge  is  noticed  from  the  nose.  Associated 
with    this    may    be   a   pustular  or  squamous  skin  disease,    and 


INFANTILE  SYPHILIS.  237 

copper-colored  discolorations.  Occasionally  there  are  unpleasant 
cicatrices  or  marks  of  an  intra-uterine  lesion. 

In  otlier  cases,  and  more  frequently,  the  disease  first  manifests 
itself  two  or  three  weeks  after  birth  in  the  appearance  of  the 
syphilitic  exanthemata  or  vesicula.  Following  this,  there  is  the 
deterioration  of  the  general  health,  above  named,  with  squamous, 
papular,  and  pustular  eruptions,  and  the  associate  ulcerations  of 
the  throat  and  mouth.  At  a  still  further  advanced  stage,  there 
is  disease  of  the  nasal  cavities,  mucous  tubercles  about  the  anus, 
and  finally  disease  of  the  bones. 

Dr.  Golding  Bird  described  a  characteristic  snuffling  as  one  of 
the  most  marked  symptoms  of  infantile  syphilis.  With  this,  the 
"  puckered  mouth,  the  position  of  the  very  characteristic  erup- 
tion round  the  lips  and  anus,  in  addition  to  the  peculiar  and 
fissured  appearance  of  the  surface  from  which  the  scales  have 
faded,  will  seldom,  if  ever,  fail  to  convert  a  suspicion  of  the  dis- 
ease into  positive  certainty." 

Diagnosis. — While  it  is  sometimes  easy  to  make  the  diagnosis, 
the  symptoms  being  characteristic,  as  above  described,  at  others 
it  is  extremely  difficult.  These  may  be  but  the  symptoms  of  bad 
blood  and  impaired  nutrition,  as  described  in  the  quotation  from 
Hutchinson.  Yet  whenever  one  form  of  cutaneous  eruption 
follows  another,  after  a  while  associated  with  disease  of  the 
throat  and  nasal  cavities,  and  attended  by  impairment  of  the 
general  health,  we  will  have  cause  to  make  strict  inquiry  whether 
there  is  the  peculiar  discolorations  of  the  skin  or  not. 

Prognosis. — When  the  symptoms  of  constitutional  syphilis 
are  present  at  birth,  the  prognosis  is  unfavorable;  indeed,  as  a 
general Vule,  it  is  better  that  such  children  should  die  early,  for 
it  is  almost  an  impossibility  for  it  to  be  removed  and  good  health 
restored.  But  when  it  appeal's  some  weeks  after  birth,  in  the 
form  of  syphilida,  in  a  well-developed  child,  we  may  expect  to 
efiect  a  permanent  cure,  if  the  mother's  health  is  not  much 
impaired. 

But  in  most  of  these  cases,  the  evidence  of  the  syphilitic  lesion 
will  still  remain  as  named.  The  disease  makes  a  permanent  im- 
press on  the  nutrition  of  the  individual,  and  may  be  seen  for 
several  generations,  though  all  its  active  symptoms  are  arrested. 


^8  DISEASES  OF  CHILDREN. 

Treatment. — The  objects  of  treatment  in  hereditary  syphilis 
are :  to  increase  the  process  of  retrograde  matamorphosis,  and 
the  removal  of  the  broken-down  material  by  way  of  the  skin, 
kidneys,  and  bowels ;  and  to  improve  digestion,  assimilation, 
blood-making,  and  nutrition,  thus  renewing  the  blood  and  tissues 
with  healthy  material. 

This  must  be  carefully  done,  for  the  influence  of  the  syphilitic 
poison  is  to  depress  vitality,  and  it  is  much  easier  to  break  down 
tissue  than  to  replace  it.  The  two  processes— waste  and  renewal 
— should  go  on  together,  the  one  being  the  exact  complement  of 
the  other.  Thus,  as  time  passes,  the  syphilized  blood  and  tissues 
are  replaced  with  new  material  not  contaminated  with  the  poison, 
and  in  the  course  of  some  months  the  disease  is  wholly  removed. 

There  is  no  specific  against  the  syphilitic  virus ;  if  there  was 
its  administration  would  suffice.  The  use  of  mercury  and  arsenic 
temporarily  arrests  its  activity  in  some  cases,  but  they  sometimes 
render  it  difficult  of  cure.  When  the  tongue  is  small  and  red,  I 
make  the  following  prescription  :  I^  Donovan's  Solution  of 
Arsenic  gtt.  x.  to  gtt.  xx.,  Tinct.  Phytolacca  gtt.  x.,  water  5iv., 
a  teaspoonful  every  four  hours.  When  indicated  it  sometimes 
exerts  a  remarkable  influence,  clearing  the  skin,  arreeting  the 
ulcerative  process,  and  improving  digestion  and  nutrition.  In 
same  cases  the  mother  may  be  put  upon  the  same  remedies  in 
larger  doses,  as  :  ^i  Donovan's  Solution  5jv  Tinct.  Phytolacca 
Sij.,  water  Siv.,  a  teaspoonful  three  or  four  times  a  day. 

Iodide  of  Potassium  is  an  admirable  remedy  when  the  tongue 
is  broad  and  has  a  leaden  pallor.  Sometimes  the  gums  and 
mucous  membranes  show  the  same  pallor.  For  the  child  I  order: 
!l^  Iodide  of  Potassium  5j-j  water  Siv.,  from  half  to  one  tea- 
spoonful every  three  or  four  hours.  For  the  mother,  if  the  child 
is  nursing,  the  proportions  of:  I(s  Iodide  of  Potassium  5ss., 
water  Siv.,  a  teaspoonful  three  or  four  times  a  day.  Sometimes 
much  smaller  doses  may  answer  for  both  child  and  mother. 

I  prefer  to  treat  the  young  child  partly  through  the  mother, 
if  it  is  nursed.  She  maybe  placed  upon  the  use  of  the  vegetable 
alteratives — Corydalis,  Alnus,  Rumex,  Stillingia,  etc. —  using 
them  in  weak  infusion,  but  quite  freely.  They  can  be  gotten  in 
pleasant  form  by  the  use  of  some  agreeable  aromatic,  as  in  the 
following  formula  :  ^  Corydalis  Sss.,  Alnus  and  Sassafras,  aa. 
%].,  boiling  water  Oiv.,  put  in  a  covered  vessel  and  keep  hot  for 
four  hours,  then  strain  and  sweeten  to  the  taste.     Any  aromatic 


INFANTILE   SYPHILIS.  239 

that  the  patient  might  prefer  can  be  substituted  for  the  sassafras. 
In  using  the  vegetable  alteratives,  I  think  it  best  to  change 
them  every  week,  as  we  may  in  this  way  obtain  a  stronger  in- 
fluence, and  the  remedies  are  less  distasteful. 

With  this  the  physician  may  give  acetate  of  potash  to  the  ex- 
tent of  three  drachms,  or  iodide  of  potassium  to  the  amount  of 
from  one-half  to  one  drachm  daily. 

.  At  the  same  time  the  patient,  if  past  the  second  summer,  is 
put  upon  the  use  of  iron  and  the  bitter  tonics,  and  has  a  full 
diet  in  which  animal  food  preponderates.  Occasionally  we  will 
find  that  the  tonic  and  stomachic  is  most  efficient  when  com- 
bined with  small  doses  of  Podophyllin,  as  in  the  following  for- 
mula :  I^  Podophyllin  gr.  j.,  Hydrastia,  Quinine,  aa.  gr.  xx., 
divide  in  twenty  powders,  and  give  one  three  times  a  day. 

The  compound  tonic  mixture,*  the  formula  for  which  will  be 
found  in  the  foot  note,  is  an  excellent  remedy,  and  may  be  em- 
ployed in  this  case  with  advantage ;  or  in  place  of  it,  we  may 
sometimes  use  the  following :  ^  Tincture  of  Muriate  of  Iron 
5ss.,  Solution  of  Strychnia  5j',  Glycerine  5iijss.,  a  teaspoonful 
four  times  a  day. 

The  treatment  of  the  child  may  consist  in  part  of  the  adminis- 
tration of  the  alterative  infusions  already  named.  They  should 
be  made  pleasant,  so  that  the  child  will  take  them  freely  and 
without  disgust. 

Iron  with  glycerine,  as  so  frequently  recommended,  will  prove 
the  best  stomachic  and  restorative.  If  the  child  is  feeble,  especi- 
ally if  there  is  occasional  febrile  action,  I  like  the  inunction  of 
quinine,  indeed,  I  am  not  certain  but  what  it  will  be  found  of 
advantage  in  most  cases. 

I  am  partial  to  the  use  of  alterative  baths  in  infantile  syphilis, 
and  have  been  able  to  obtain  a  very  decided  benefit  from  them. 

*  Formula  for  Compound  Tonic  Mixture.— R  Ferri  Sulph.  3j., 
Soda  Phos.  3vj.,  Quinia  Sul.  grs.  192,  Sul.  Acid  dil.  q.  s.,  Aqua  Am- 
monia q.  s.,  Strychnia  grs.  vj.,  Acid  Phosph.  dil.  f^xiv.,  Sacch.  Alba 
^xiv.  Dissolve  the  Iron  in  .^j  of  boiling  water,  and  the  Phosphate  of 
Soda  in  ,lij.,  of  boiling  water.  Mix  the  solutions  and  wash  the  precipi- 
tated phosphate  of  iron  until  the  washing  is  tasteless.  With  q.  s.  of  dil. 
sul.  acid  dissolve  the  quinine  in  two  ounces  of  water,  precipitate  the 
quinine  with  ammonia,  and  carefully  wash.  Dissolve  the  phosphate  of 
iron  and  the  quinine  thus  obtained,  as  also  the  strychnia,  in  the  dilute 
phosphoric  acid,  then  add  the  sugar  and  dissolve  the  whole  without  heat. 


240  DISEASES   OF    CHILDREN. 

I  generally  employ,  externally,  the  same  remedies  that  are  used 
internally.  For  instance,  if  Corydalis  and  Rumex  are  given,  a 
strong  infusion  of  the  same  is  used  as  a  bath. 

POISONOUS   BITES   AND   STINGS. 

Occasionally  a  physician  is  called  to  treat  a  child  who  has  been 
bitten  by  a  poisonous  serpent;  but  more  frequently  one  who  is 
suffering  the  effects  of  the  sting  of  the  bee,  wasp,  or  others  of 
like  species. 

The  history  of  the  accident  in  these  cases  is  usually  plain,  and 
their  symptoms  very  marked ;  so  that  there  is  little  danger  of 
mistaking  the  character  of  the  injury. 

Symptoms. — The  symptoms  from  the  bite  of  a  poisonous  ser- 
pent are  manifest  in  a  short  time.  The  patient  is  prostrated,  the 
countenance  pale  and  listless,  body  bedewed  with  a  cold  perspi- 
ration, the  pulse  small,  rapid  and  fluttering,  with  drowsiness  and 
disinclination  to  speak  or  answer  questions. 

The  part  bitten  usually  swells  rapidly,  and  becomes  bluish 
discolored.  In  some  cases  the  swelling  extends  to  adjoining 
parts,  and  finally  the  whole  body  is  more  or  less  swollen  and 
sometimes  discolored. 

All  the  symptoms  are  those  of  prostration,  and  we  may  regard 
the  poison  as  a  depressant,  having  a  somewhat  similar  action  to 
hydrocyanic  acid,  and  at  the  same  time  a  blood-poison,  setting 
up  a  process  of  decomposition. 

The  poison  of  the  sting  of  the  bee,  wasp,  hornet,  and  others 
of  like  species,  is  somewhat  similar  in  kind,  though  in  much  less 
degree.  Usually  we  will  find  the  disturbance  principally  local, 
except  the  irritation  of  the  nervous  system  from  the  extreme 
pain,  which  sometimes  goes  so  far  as  to  produce  convulsions. 
The  part  is  much  swollen,  pale  at  the  part  stung,  but  with  a  red 
areola,  and  is  exquisitely  painful. 

In  some  persons,  extremely  susceptible  to  the  influence  of  the 
poison,  we  will  have  marked  prostration  from  a  single  sting. 
Usually,  however,  the  constitutional  symptoms  are  seen  when  the 
person  has  been  stung  in  many  places.  In  these  cases  the  pulse 
is  small  and  feeble,  the  extremities  cold,  the  face  pallid,  a  sense 


BITES   AND   STINGS.  241 

of  weight  and  oppression  in  the  prsecordia,  difficulty  of  breath- 
ing, and  sense  of  general  prostration.  In  one  case  that  came  to 
my  knowledge  the  patient  was  unconscious  for  some  hours,  and 
seemingly  lifeless  for  a  time.  As  a  general  rule,  these  symptoms 
pass  off  in  the  course  of  twenty-four  hours. 

Treatment. — The  treatment  for  the  bite  of  a  serpent  will  be 
of  a  stimulant  character.  Let  the  wound  be  freely  incised,  and 
cupped,  or  drawn  by  the  mouth,  and  afterward  a  strong  solution 
of  ammonia  applied.  Place  the  patient  in  bed,  covering  warmly, 
and  applying  dry  heat  freely. 

Give  internally  the  aromatic  spirit  of  ammonia  with  tincture 
of  asafoetida,  in  full  doses,  repeated  frequently,  with  as  much 
strong  coffee  as  the  patient  can  drink. 

The  common  treatment  in  the  South-west  is  to  give  whisky 
freely,  to  the  extent  of  a  pint  or  more  in  a  short  time,  for  an 
adult ;  but  I  think  it  doubtful  whether  this  is  as  good  as  the 
plan  proposed. 

In  the  case  of  a  sting  I  have  slices  of  raw  onion  applied  to  the 
part,  and  changed  frequently.  It  is  very  certain  and  speedy  in 
its  action,  relieving  the  pain,  and  dispersing  the  swelling,  usually 
in  the  course  of  half  an  hour.  If  there  are  a  number  of  stings, 
it  should  be  applied  to  every  one  of  them,  and  bound  on  firmly. 

In  case  the  general  symptoms  are  developed,  I  should  recom- 
mend the  treatment  given  for  the  bite  of  a  serpent.     If  convul- 
sions ensue,  chloroform  will  probably  prove  the  best  remedy. 
16 


242  DISEASES  OF   CHILDREN. 

CHAPTER    VI. 
DISEASES  OF  THE  RESPIRATORY  APPARATUS. 


The  respiratory  apparatus  consists  of  the  cavities  of  the  nose, 
the  pharynx,  larynx,  trachea,  bronchial  tubes,  parenchyma  of  the 
lung,  and  the  investing  membrane — the  pleura.  Each  of  these 
parts  may  be  the  seat  of  diseased  action  separately,  or  two  or 
more  may  be  engaged  at  one  time.  The  diseases  are  mostly  of 
an  inflammatory  character,  but  in  addition  we  have  them  de- 
pendent upon  morbid  innervation,  and  change  of  structure  de- 
pendent upon  causes  other  than  inflammatory. 

We  diagnose  these  diseases  in  part  by  the  general  symptoms, 
as  we  do  affections  of  other  parts  of  the  body.  But  to  confirm 
such  diagnosis  and  render  it  more  exact,  we  are  guided  by  cer- 
tain 'physical  signs,  manifest  to  the  senses  of  sight,  hearing,  and 
touch.  This  is  called  physical  diagnosis,  to  distinguish  it  from 
the  ordinary  means  by  general  symptoms. 

We  purpose  giving  but  a  brief  space  to  the  subject  of  physical 
diagnosis  here,  merely  pointing  out  the  differences  between  the 
child  and  the  adult.  For  further  information  the  reader  is  re- 
ferred to  special  monographs  on  the  subject,  or  to  treatises  on  the 
practice  of  medicine. 

The  information  for  physical  diagnosis  is  obtained  from  an 
examination  of  the  conformation  of  the  thorax,  respiration,  cough, 
sputa,  and  from  auscultation  and  percussion. 

CoNFOEMATiON  OF  THE  Thorax. — But  little  information  is 
obtained  from  the  form  of  the  thorax  in  acute  disease.  In  some 
cases  of  chronic  disease,  the  narrow  and  flattened  chest,  with 
feeble  respiratory  power,  will  be  additional  evidence  of  feeble 
viablility.  But  it  is  of  more  importance  if  it  impresses  Upon  us 
the  necessity  of  passive  and  active  exercise  of  the  thoracic  mus- 
cles, and  increased  inspiratory  effort  to  obtain  a  better  develop- 
ment. There  is  no  doubt  but  that  the  movement  cure  may  be 
applied  in  this  case  with  great  advantage. 

RESPIRATION. — The  respiratory  movements  of  the  child  are 
more  open  and  free  than  in  the  adult,  and  at  the  same  time  more 
superficial.     Clianges  in   the  respiratory  movements   have  less 


DISEASES  OF  EESPIRATORY  ORGANS.  243 

diagnostic  value  than  in  the  adult,  because  they  may  be  influ- 
enced by  slight  lesions,  or  by  derangemeuts  of  the  nervous  sys- 
tem. Considerable  irregularity  of  the  respiratory  movement  is 
permitted,  without  seriously  interfering  with  the  function. 

Respiration  normally  is  both  thoracic  and  abdominal ;  if  it  is 
changed  in  this  respect,  it  is  evidence  of  disease.  Thoracic  res- 
piration is  caused  by  acute  inflammation  of  the  liver,  stomach, 
or  spleen,  or  from  peritonitis ;  but  the  most  frequent  cause  is 
from  an  irritable  state  of  the  bowels,  sometimes  met  with  in 
severe  cases  of  colic.  It  is  abdominal  in  pleurisy,  pericarditis, 
and  in  extreme  debility. 

Respiration  is  increased  in  frequency  from  two  causes  :  First, 
in  consequence  of  an  increased  frequency  of  the  circulation,  to 
which  it  bears  the  normal  relation  of  one  to  four ;  and  second, 
from  disease  of  the  respiratory  apparatus,  the  capacity  of  the 
lungs  being  lessened,  the  respiratory  movement  is  proportionally 
frequent. 

A  slow  and  free  respiration  indicates  an  easy  circulation  of  the 
blood,  sound  lungs,  and  an  unimpaired  distension  of  them.  If 
the  respiration  is  large  and  attended  with  difficulty,  much  exer- 
tion being  necessary,  it  indicates  loss  of  nervous  power  and 
approaching  coma  or  stupor.  The  short  respiration,  when  un- 
attended with  pain,  is  a  very  certain  symptom  of  obstruction  of 
the  lungs. 

Difficult  respiration  is  manifested  by  labored  breathing,  the 
inclination  being  to  assume  a  sitting  position,  and  in  the  child 
by  the  clutching  movements  of  the  arras  and  hands.  There  are 
also  the  additional  evidences  from  imperfect  aeration  of  the 
blood. 

Cough. — Cough  is  an  indication  of  irritation  of  the  respira- 
tory mucous  membranes,  and  may  be  produced  from  disease  of 
any  part.  The  purpose  fulfilled  by  the  normal  act  of  coughing 
is  the  removal  of  irritating  matters  which  may  be  in  the  air- 
passages.  The  irritation  of  disease  gives  the  sensation  of  some- 
thing irritant  within  the  bronchial  tubes,  hence  the  cough.  The 
act  of  coughing  removes  increased  secretion  of  mucous,  and 
keeps  the  air-passages  free  for  the  performance  of  the  respiratory 
function. 

Cough  may  be  sympathetic — depending  upon  disease  of  some 
part  other  than  the  lungs,  as  when  it  arises  from  disease  of  the 


244  DISEASES   OF   CHILDREN. 

stomach,  liver,  or  other  abdominal  viscera.  Or  it  may  be  de- 
pendent upon  the  irritation  of  the  nervous  centers,  especially  of 
the  base  of  the  brain,  as  we  have  a  marked  example  in  whoop- 
ing-cough. 

The  short  irritative  cough  is  generally  met  with  in  the  first 
stages  of  inflammation  of  the  parenchyma  of  the  lungs.  The 
hoarse  and  stridulous  cough  results  from  laryngeal  disease.  The 
hollow,  rattling  cough  is  found  in  bronchitis,  with  increased  se- 
cretion. A  dry  cough  indicates  want  of  secretion;  a  moist  or 
mucous  cough,  increased  secretion. 

Sputa. — While  we  obtain  considerable  information  in  diseases 
of  the  adult  from  an  examination  of  the  sputa,  we  learn  but 
little  in  diseases  of  childhood.  The  adult  raises  the  secretion 
by  an  act  of  coughing,  and  spits  it  out ;  the  child  raises  it  to  the 
larynx,  and  swallows  it.  If  the  sputa  is  ejected,  and  can  be 
examined,  it  will  give  the  same  information  as  in  the  adult. 

Percussion. — The  practice  of  percussion  does  not  give  the 
same  information  as  in  the  adult.  The  walls  of  the  chest  are 
not  so  elastic,  and  the  comparative  resonance  or  dullness  is 
affected  by  minor  circumstances  in  a  greater  degree.  Neither  do 
we  have  solidification  of  the  lungs  even  in  pneumonia,  as  in  the 
adult. 

Still,  resonance  on  percussion  gives  the  information  that  the 
lungs  are  permeable  for  air,  and  there  is  no  structural  reason 
for  impaired  respiration.  And  dullness  on  percussion  is  evidence 
of  congestion,  or  of  effusion  into  the  structure  of  the  lungs. 

Auscultation. — We  obtain  the  most  certain  information  in 
regard  to  the  condition  of  the  respiratory  organs  from  ausculta- 
tion ;  yet  should  we  be  guided  by  the  statements  of  writers  on 
auscultation,  we  would  be  led  into  frequent  errors.  We  have  no 
sibilant,  sonorous,  dry  crackling,  crepitant,  subcrepitant,  mucous,  or 
cavernous  rhonchi  in  children,  and  those  who  auscultate  witli 
the  expectation  of  hearing  such  sounds  will  be  mistaken. 

The  sounds  heard  may  be  divided  into  two  classes,  dry  and 
moist  blotcing  sounds ;  they  are  all  blowing  sounds,  and  I  use  the 
word  in  its  literal  signification.  They  are  dry  in  various  degrees, 
and  tliey  are  moist  in  various  degrees,  which  the  ear  soon  learns 
to  appreciate.     Dryness  indicates  an    arrest  of   secretion,    and 


CORYZA.  245 

contraction  of  the  bronchial  tubes  ;  as  is  the  dryness,  so  is  this 
condition.  Moist  blowing  sounds  indicate  the  establishment  of 
secretion,  and  in  proportion  to  the  moisture,  or  rattling,  is  the 
abundance  of  the  secretion. 

The  sounds  also  give  evidence  of  the  condition  of  the  bronchial 
tubes,  as  regards  tone.  If  the  sound  is  well  defined  or  acute, 
the  tubes  are  contracted,  and  in  proportion  as  the  sound  is  waver- 
ing and  hollow,  they  are  relaxed.  Getting  the  timbre  of  the 
sound  is  the  most  important  part  of  the  education  of  the  ear. 

The  respiratory  murmur  is  very  distinctly  heard  in  the  child, 
being  once  or  twice  as  loud  as  in  the  adult,  so  that  beginners  in 
auscultation  are  recommended  to  commence  the  training  of  the 
ear,  and  to  get  a  better  knowledge  of  this  natural  sound,  by 
auscultation  of  the  child.  When  this  sound  is  present  we  know 
the  parenchyma  of  the  lung  is  not  involved.  It  is  changed  in 
inflammation  of  the  lungs,  becoming  coarser  and  less  even,  and 
broken  by  mucous  cracklings.  It  is  masked  by  the  moist  blow- 
ing sounds  of  bronchitis,  and  these  sometimes  mask  the  change 
in  its  character — in  the  latter  stages  of  an  inflammation  of  the 
lungs. 

CORYZA. 

A  mild  form  of  coryza  is  of  very  common  occurrence  in  the 
child,  and  while  it  is  mild  and  demands  but  little  treatment,  it  is 
a  source  of  great  annoyance  to  the  child,  and  from  the  restless- 
ness that  attends  it,  to  the  family. 

The  severe  form  of  the  disease  is  a  true  inflammation  of  the 
nasal  cavities,  and  causes  considerable  constitutional  disturbance 
in  addition  to  the  local  uneasiness. 

Symptoms. — In  the  first  form,  the  nose  becomes  stopped  by 
accumulations  of  mucus,  and  the  child  draws  its  breath  through 
the  nose  with  difficulty,  and  finally  is  compelled  to  breathe 
wholly  through  the  mouth.  The  adult  finds  such  a  state  of 
things  sufficiently  annoying,  but  the  child  can  see  no  reason  for 
it,  and  no  cause  why  it  shall  have  patience  under  the  infliction, 
and  consequently  makes  known  its  objections  in  violent  crying. 

The  nose  may  remain  stopped  in  this  way  for  several  hours, 
and  it  may  be  repeated  day  after  day  for  a  week  or  more.  Usually 
it  is  associated  with  slight  cold,  and  when  this  passes  away  the 
trouble  ceases. 


246  DISEASES  OF  CHILDREN. 

In  the  second  form  there  is  a  similar  condition  of  the  nose,  and 
the  same  restlessness  and  suffering  in  consequence.  In  addition 
to  this  the  child  manifests  symptoms  of  febrile  action  and  arrest 
of  secretion ;  the  face  is  flushed,  the  eyes  injected,  and  the  head 
is  hot. 

The  closing  of  the  nose  in  this  case,  during  the  first  two  or 
three  days,  is  dependent  upon  swelling  of  the  nasal  mucous 
membrane.  After  this  there  is  free  secretion  and  discharge,  but 
when  this  is  retained  it  closes  the  passages. 

With  the  subsidence  of  the  fever  and  the  establishment  of 
secretion,  the  disease  passes  away. 

Treatment. — In  the  first  and  simple  form,  thoroughly  rubbing 
the  nose  and  over  the  frontal  sinus  with  hot  lard,  or  any  fatty 
matter,  will  give  present  relief.  If  the  child  is  suffering  from 
cold,  the  use  of  an  infusion  of  Asclepias  will  generally  be  all 
that  is  required.  \ 

In  the  second  form  of  the  disease  the  patient  is  put  upon  the 
use  of  the  sedative.  Aconite  or  Veratrura,  in  the  usual  doses,  and 
the  action  is  aided  by  the  hot  foot-bath.  In  some  cases  the  dis- 
charge is  acrid,  and  though  the  child  may  not  complain  of  burn- 
ing, we  can  see  by  the  expression  of  its  face  that  there  is  much 
irritation  of  the  mucous  membrane  :  we  use  Rhus  with  the  Aco- 
nite. If  the  child  is  dull,  and  wants  to  sleep  a  great  deal,  Bel- 
ladonna is  used.  If  the  head  is  hot,  and  the  face  flushed,  the 
remedy  is  Gelseminum.  If  the  tongue  is  pale,  the  throat  sore, 
or  any  enlargement  of  the  lymphatic  glands,  give  Phytolacca. 
Some  cases  will  present  themselves  in  which  marked  benefit  will 
be  derived  from  sulphite  of  soda  or  sulphurous  acid.  The  first, 
if  the  tongue  is  pallid  and  dirty,  or  if  there  is  eczema ;  the  sec- 
ond when  the  tongue  is  red  and  dirty,  and  the  tissues  somewhat 
puffy. 

The  use  of  inhalations  of  the^  vapor  of  water  and  vinegar  give 
great  relief,  and  may  be  employed  several  times  a  day  in  bad 
cases.  In  place  of  this  we  may  use  a  friction  to  the  nose  of  tinc- 
ture of  Aconite  gtt.  x.  to  gtt.  xx.,  lard  .5j.;  mix. 

CHRONIC    CATARRH. 

Chronic  catarrh  is  not  of  as  frequent  occurrence  in  childhood 
as  in  the  adult,  yet  we  meet  with  oases  from  the  age  of  three 
years  upwards.     In  some  cases  it  seems  to  be  dependent  upon  an 


CHRONIC  CATAREH.  247 

enlargement  of  the  mucous  follicles,  thickening  of  the  mucous 
membrane,  and  increased  circulation.  In  this  case  the  discharge 
from  the  nose  is  of  mucus  only.  In  other  cases  there  is  a  true 
chronic  inflammation,  producing  thickening  of  the  mucous  mem- 
brane and  superficial  ulceration,  and  the  discharge  is  muco- 
purulent. 

Symptoms. — In  the  first  case  there  is  too  free  secretion  from 
the  nose,  the  constant  discharge  becoming  disagreeable.  In  addi- 
tion to  this  the  voice  is  changed,  and  has  a  nasal  tone,  which  is 
sometimes  disagreeable.  In  some  cases  the  nasal  cavities  become 
closed  at  times,  from  accumulation  of  the  secretion,  and  this  is 
very  unpleasant  to  the  patient. 

In  the  second  case  there  is  the  free  discharge  from  the  nose, 
but  now  it  is  frequently  fetid,  and  is  otherwise  unpleasant.  The 
patient  complains  of  pain  over  the  nasal  bones,  and  frequently  a 
frontal  headache,  which  may  be  located  in  the  frontal  and  orbital 
sinuses.  In  addition  to  this,  there  is  the  unpleasant  nasal  tone 
to  the  voice,  and  the  occasional  stopping  up  of  the  nose,  com- 
pelling the  child  to  breathe  through  the  mouth. 

In  some  cases  the  disease  is  confined  principally  to  the  superior 
portion  of  the  cavity,  extending  backward  to  the  posterior  nares. 
In  others  the  posterior  nares  and  the  upper  part  of  the  pharynx 
back  of  the  soft  palate,  are  principally  involv^ed.  This  gives  rise  to 
a  peculiar  hollow  voice,  and  occasionally  to  some  difficulty  in 
articulation,  and  an  unpleasant  gurgling  noise  in  swallowing. 
In  both  of  these  cases  the  secretion  pours  backward,  and  drop- 
ping into  the  pharynx,  is  ejected  by  an  act  of  hawking  and  ex- 
pectoration. 

The  general  health  suffers  more  or  less  as  the  disease  continues, 
especially  in  the  second  form.  The  appetite  is  impaired,  diges- 
tion deranged,  and  poor  blood  is  formed,  and  from  this  we  have 
imperfect  nutrition,  I  do  not  think  such  cases  are  necessarily 
scrofulous,  but  as  the  disease  progresses,  a  condition  very  similar 
to  scrofula  is  developed. 

Diagnosis. — The  diagnosis  is  not  difficult,  as  the  continued 
abundant  discharge  from  the  nose,  its  occasional  closure,  the 
nasal  tone  of  voice,  and  the  pain  and  uneasy  sensations  in  the 
nose  and  frontal  region,  are  very  prominent. 


248  DISEASES  OF  CHILDREN. 

Prognosis. — The  disease  will  rarely  if  ever  get  well  without 
treatment ;  but  an  appropriate  general  and  local  treatment,  if 
continued  sufficiently  long,  will  effect  a  radical  cure. 

Treatment. — In  many  cases  a  general  treatment  is  necessary 
to  success;  in  some  cases,  however,  nothing  but  local  means  will 
be  indicated.  The  general  treatment  will  vary  according  to  the 
indications,  and  much  care  will  be  necessary  to  select  the  right 
remedy.  The  possible  remedies  might  be  named,  as  Arsenic, 
Iron,  Lime,  Sulphite  of  Soda,  Sulphurous  Acid,  Hamamelis, 
Alnus,  Scrophularia,  Phytolacca,  Donovan's  Solution,  Iodide  of 
Potassium.  The  relaxed,  atonic  skin,  with  feeble  circulation, 
will  be  benefited  by  arsenic;  pallid  skin,  with  blue  veins,  iron; 
dusky  redness  of  mucous  membranes  of  nose  and  throat,  with 
occasional  erysipelatous  flushings  of  skin,  tincture  of  muriate  of 
iron.  Lime  is  used  when  there  is  acid  dyspepsia,  or  a  tendency 
to  inflammation  of  cellular  tissue — lime-water  or  hypophosphite 
of  lime ;  sulphite  of  soda,  if  there  is  eczema  of  the  face ;  sul- 
phurous acid,  if  there  is  deep  redness  of  mucous  membranes, 
with  offensive  discharge ;  Hamamelis,  if  the  tissues  are  full  and 
atonic ;  Alnus  and  Scrophularia,  if  there  is  purulent  secretion, 
with  the  formation  of  unpleasant  crusts  or  scabs ;  Phytolacca, 
if  the  throat  is  sore,  or  the  cervical  glands  enlarged ;  Donovan's 
solution,  if  the  bones  are  being  involved,  the  skin  dirty,  and 
especially  if  a  syphilitic  taint  is  suspected ;  iodide  of  potassium, 
if  there  is  a  broad  atonic  tongue,  with  leaden  pallor. 

In  some  cases  I  have  employed  Rhus  with  Aconite  or  Vera- 
trum,  with  most  marked  benefit.  The  Rhus  has  the  usual  indi- 
cations, frontal  headache,  persistent,  with  burning  in  the  eyes  or 
nose.  The  Aconite  is  suggested  by  the  irritable  tonsils  and 
throat,  and  the  Veratrum  by  cough  and  mucous  rattling  in 
bronchia. 

At  the  same  time  the  child  should  have  its  regular  bath  every 
one  or  two  days,  using  the  alkalies  when  indicated,  the  tonic 
bath  if  the  child  is  anaemic,  or  the  fatty  inunction  if  the  skin  is 
dry  and  harsh. 

With  young  children  it  is  somewhat  difficult  to  make  proper 
use  of  local  remedies.  With  such  I  prefer  to  use  them  by  inha- 
lation, or  with  the  steam  or  air  atomizer.  In  this  way  they  can 
bo  brono;ht  into  direct  contact  Mith  the  diseased  structures. 
When  the  child  is  old  enough   (six  years)  to  use  it,  the  nasal 


CHRONIC   CATARRH.  249 

douche  may  be  employed  (Thudicum's  method),  the  fluid  being 
passed  iuto  one  nostril  and  flowing  through  the  nasal  cavity  and 
out  at  the  other. 

The  Thudicum  apparatus  consists  of  a  glass  vessel,  holding  a 
pint  or  quart,  to  the  bottom  of  which  is  attached  a  piece  of  rub- 
ber tubing  six  or  eight  feet  long,  furnished  with  a  stop-cock  to 
turn  on  or  off  the  fluid,  and  a  nose-piece  to  fit  in  one  nostril. 
The  method  of  using  it  is  as  follows  :  Place  the  vessel  containing 
the  fluid  on  a  shelf  or  stand  three  or  four  feet  higher  than  the 
patient's  head,  and  place  the  nose  piece  in  one  nostril ;  now  let 
the  patient  open  his  mouth,  breathing  through  it  entirely,  turn 
on  the  fluid,  and  it  will  pass  through  the  nose,  and  out  of  the 
other  nostril,  as  described.  A  vessel  may  be  placed  before  the 
patient  to  receive  it. 

If  such  apparatus  is  not  at  hand,  one  may  be  improvised  by 
taking  an  ordinary  bottle  to  contain  the  fluid,  and  a  piece  of  half- 
inch  rubber  tubing  six  or  eight  feet  long  to  conduct  it  to  the 
nose.  Place  one  end  of  the  tube  in  the  bottle  so  that  it  may 
reach  to  the  bottom,  apply  the  mouth  to  the  other  end,  and  by 
suction  draw  the  fluid  through,  then  compressing  it  with  the 
fingers,  introduce  it  into  the  nostril,  and  proceed  as  before.  It 
is  the  ordinary  syphon,  and  will  continue  to  discharge  until  all 
the  fluid  in  the  vessel  is  removed ;  its  force  will  depend  on  the 
elevation  of  the  vessel.  Another  method  is  to  use  the  ordinary 
rubber- pump  syringe,  the  fluid  passing  into  one  side,  going 
through  the  nasal  cavities  and  out  at  the  other  nostril,  so  long 
as  the  patient  breathes  through  the  mouth.  With  either  of  these, 
so  soon  as  the  patient  shuts  the  mouth  the  fluid  will  pass  down 
the  throat,  or  into  the  larynx  if  the  patient  makes  an  inspiration. 
Of  course  the  sense  of  strangulation  stops  its  use  until  the  pa- 
tient gets  breath  and  starts  fairly  again. 

The  remedies  used  by  the  atomizer  will  differ  somewhat  from 
those  used  by  the  hydrostatic  method.  I  have  obtc^ined  good 
results  from  the  use  of  a  solution  of  chlorate  of  potash  (gr.  x.  to 
water  5iv.),  alternated  with  Pond's  extract  of  Hamamelis;  or  in 
place  of  the  preparation  of  Hamamelis  named,  we  may  use  one 
part  of  the  tincture  to  three  of  water.  When  the  discharge  is 
purulent  and  offensive  we  may  use  the  solution  of  permanganate 
of  potash  grs.  x.  to  water  Siv  to  Sviij.,  depending  upon  the  con- 
dition of  the  mucous  membrane.  In  place  of  this,  a  solution  of 
carbolic  acid,  one  part  to  twenty,  may  be  used  with  good  results. 


280  DISEASES  OF   CHILDREN. 

Withiq  the  past  two  or  three  years  I  have  used  a  solution  of 
Salicylic  Acid  with  Borax  or  Avith  chlorate  of  potash  with  excel- 
leut  effect.  The  strength  would  be,  I^  Salicylic  Acid  gr.  x., 
Borax  or  Chlorate  of  Potash  gr.  x.,  water  .^iv.  The  apparatus 
for  atomizing  is  now  so  good  and  so  cheap,  (the  Essex  selling 
for  $1.50  and  $2.00,  the  Adams  for  $2.00,)  and  the  method  is  so 
easily  employed  even  with  young  children,  that  I  give  it  the 
preference. 

It  will  not  do  to  forget  the  old  means  in  looking  after  the  new, 
and  there  are  cases  in  which  a  filtered  infusion  of  equal  parts  of 
Alnus,  Rumex,  and  Quercus  Rubra,  will  be  preferable  to  any 
other  remedy.  These  are  cases  of  profuse  secretion  of  muco-pus, 
with  probable  disease  of  bone,  and  marked  development  of  the 
nasal  voice. 

With  the  hydrostatic  apparatus,  we  use  a  solution  of  common 
salt  5SS.  to  the  pint  of  water,  to  cleanse  the  nose  and  remove  the 
mucus  or  muco-pus.  Not  unfrequently  considerable  quantities 
of  offensive  material,  with  large  unpleasant  looking  crusts,  will 
be  brought  away.  Following  this,  use  a  solution  of  chlorate  of 
potash,  varying  in  strength  from  gr.  x.  to  o]-,  to  the  pint  of 
water.  In  a  large  number  of  cases  we  find  that  these  simple 
means  are  sufficient  for  a  cure.  Occasionally  it  may  be  well  to 
alternate  with  this  an  infusion  of  Hydrastis  or  Hamamelis,  or  the 
distilled  extract  of  Hamamelis  diluted  with  one  part  of  water. 

If  the  discharge  is  very  offensive,  we  employ  the  solution  of 
salicylic  acid  and  chlorate  of  potash  ;  or  instead  of  this,  a  weak 
solution  of  carbolic  acid  may  be  used. 

To  relieve  the  pain  and  unpleasant  sensations  in  the  frontal 
region,  I  always  direct  the  local  application  of  tincture  of  Aconite 
root  over  the  part.  It  is  applied  with  the  finger,  and  of  course 
is  used  in  small  quantity.  The  use  of  the  voltaic  battery,  the 
current  being  passed  from  the  nape  of  the  neck  through  to  the 
part  in  front  where  the  pain  points  or  reversed,  relieves  the 
unpleasant  sensation,  and  it  is  claimed  aids  in  the  cure. 

CHRONIC    PHARYNGITIS. 

Chronic  disease  of  the  pharynx,  fauces,  soft  palate,  and  tonsils 
is  occasionally  met  with  in  the  child,  and  is  generally  of  an  in- 
flammatory character.  All  of  these  parts  may  be  involved  in 
the  disease  at  once,  or  one  or  two  may  be  affected  separately.    It 


CHRONIC   PHARYNGITIS.  251 

is  frequently  associated  with  disease  of  the  posterior  nares,  and 
occsionally  with  disease  of  the  larynx  and  bronchia. 

Causes. — Occurring  in  persons  of  feeble  vital  power,  and 
consequently  poor  blood  and  impaired  nutrition,  we  can  easily 
see  how  any  irritation  may  progress  and  run  into  this  disease. 
With  such  conditions  of  the  system  it  is  most  frequently  caused 
by  cold,  and  follows  ordinary  sore  throat.  Repeated  attacks  of 
tonsillitis,  or  of  sore  throat,  may  give  rise  to  it  in  persons  other- 
wise of  good  constitution.  It  may  also  be  a  sequel  of  diphtheria 
which  has  prevailed  so  extensively  during  the  past  ten  years. 

Pathology. — The  mucous  membrane  covering  these  parts  is 
thickened,  the  blood-vessels,  especially  the  veins,  enlarged,  and 
the  mucous  follicles  increased  in  size  and  activity.  With  this 
changed  and  enfeebled  condition  the  transformation  of  epithelial 
cells  into  pus  cells,  and  the  reparative  material  into  pus,  is  easy  ; 
and  at  a  further  advanced  stage  erosion,  superficial  ulceration, 
and  at  last  deep  ulceration,  would  naturally  follow  this  condition 
of  the  tissues. 

Symptoms. — It  is  noticed  that  the  child  is  easily  affected  by 
cold,  frequently  complaining  of  sore  throat ;  that  it  frequently 
clears  the  throat  by  an  act  of  hawking,  and  expectorates  a  mucus 
or  muco-purulent  material  in  considerable  quantity.  There  is 
also  a  change  in  the  voice,  readily  recognized  by  one  who  has 
not  become  accustomed  to  it  like  the  family.  Quite  often  the 
child  will  make  an  unnatural  gurgling  noise  when  it  sleeps,  or  it 
may  be,  it  will  snore  like  an  adult. 

The  constitutional  lesions  vary  in  different  cases,  in  some 
marked,  and  in  others  slight,  but  as  they  are  only  incidentally 
related  to  the  disease  we  are  describing,  it  is  not  necessary  to 
enter  into  a  detailed  description. 

Diagnosis. — The  symptoms  above  named  having  drawn  our 
attention  to  the  throat  as  the  seat  of  a  disease,  we  make  an  ex- 
amination of  it,  by  placing  the  patient  in  a  good  light  and  de- 
pressing the  tongue.  I  prefer  the  use  of  a  hand-mirror  to  reflect 
the  light,  concentrating  it  in  the  throat.  In  using  this  the 
patient  is  placed  with  his  back  to  the  window,  in  such  position 
that  we  can  catch  the  direct  rays  of  the  sun  npon  the  mirror,  and 
throw   them    in  the  throat.     Or,  using  a  lamp,  which   is   more 


252  DISEASES  OF    CHILDREN. 

convenient,  it  is  placed  by  the  side  of  the  patient  on  a  level  with 
the  head,  when  the  light  may  be  readily  thrown  into  the  pharynx 
with  the  mirror. 

Making  such  examination  we  find  the  mucous  membrane 
thickened,  relaxed,  changed  in  color,  and  the  tonsils  enlarged 
and  spongy,  and  covered  by  the  mucus  or  muco-purulent  secretion. 

Treatment. — The  general  treatment  named  for  chronic 
catarrh  will  be  applicable  to  this  case.  If  called  in  consequence 
of  a  recent  cold,  (which  always  increases  the  throat  trouble,)  we 
will  administer  Aconite  with  Phytolacca  or  with  Rhus  as  may 
be  indicated.  If  the  mucous  tissues  are  deep-red  and  relaxed, 
sulphurous  acid  can  be  given  with  advantage,  especially  if  the 
tongue  is  dirty  and  the  breath  bad.  With  the  dull  purplish  color 
of  raucous  membrane,  and  sometimes  also  of  face,  the  patient 
should  have  Baptisia. 

Restoratives  are  very  generally  indicated,  and  we  select  them 
as  heretofore  named.  Minute  doses  of  Veratrum  and  Arsenic, 
Compound  Syrup  of  the  Hypophosphites,  Cod-liver  Oil,  the 
diflfent  preparations  of  malt,  Hypophosphate  of  Lime,  inunctions 
with  Quinine,  etc. 

If  the  child  is  old  enough  to  use  a  gargle  we  may  employ  the 
Hamamelis,  alternated  with  chlorate  of  potash.  The  Hamamelis 
may  be  used  in  the  form  of  the  tincture,  Sss.  to  water  Siv.,  the 
chlorate  of  potash  in  solution,  5j«  to  water  Oj.  In  place  of  the 
Hamamelis  we  may  use  the  Hydrastis,  Cornus-,  Alnus,  or  Marsh 
Rosemary. 

If  the  child  can  not  use  a  gargle,  the  same  remedies  may  be 
employed  with  the  spray  apparatus.  Occasionally  good  results 
may  be  obtained  by  using  a  remedy  in  powder,  allowing  it  to 
dissolve  on  the  tongue,  swallowing  slowly.  In  this  way  we  may 
employ  the  following :  1^  Chlorate  of  Potash  5jv  {^^  Alum  gr. 
XX.,)  Tannic  Acid  gr.  v.,  Gum  Arabic  powdered,  White  Sugar, 
aa.  5ij.;  triturate  thoroughly  and  divide  into  powders  of  five 
grains. 

In  place  of  this  we  might  use  a  pastile  or  lozenge  In  the  form 
of  Dr.  Anton's,  wliinh  has  proven  quite  available.  The  formula 
is  given  in  the  foot-note* 

*  R;  Cubebs,  fresh  and  finely  pulverized,  two  ounces;  Chlorate  Potash 
half  ounce;  Gum  Tragacanth  one  and  a  quarter  ounces;  Refined  Sugar 


TONSILLITIS.  253 

A  flannel  cloth  wrung  out  of  cold  vinegar  and  applied  around 
the  throat,  with  a  dry  flannel  over  it,  on  going  to  bed,  is  a  very 
important  aid  to  the  treatment.  If  the  vinegar  produces  irrita- 
tion of  the  skin  it  should  be  diluted.  AYhen  the  cloth  is  removed 
in  the  morning,  the  neck  and  shoulders  should  be  washed  in 
cold  water,  using  it  freely,  but  drying  with  brisk  friction.  This 
is  the  most  certain  means  to  prevent  the  frequent  taking  cold, 
which  in  some  cases  seems  to  be  the  greatest  obstacle  to  perma- 
nent recovery. 

TONSILLITIS. 

Inflammation  of  the  tonsils  is  a  very  peculiar  disease,  in  that 
the  tendency  to  it  is  hereditary  in  some  families,  and  that,  hav- 
ing once  occurred,  there  is  a  continued  predisposition  to  it,  and 
it  continues  to  recur,  sometimes  during  the  entire  life-time.  It 
is  also  peculiar,  in  that  an  inflammation  so  active  in  form  should 
be  confined  to  a  small  gland,  and  not  extend  to  adjacent  structures. 

Causes. — Tonsillitis  occurs  most  frequently  at  the  commence- 
ment or  breaking  up  of  winter,  when  the  weather  is  very  change- 
able. A  slight  cold,  contracted  at  such  times,  will  be  followed 
by  an  attack. 

Pathology. — The  tonsils  are  composed  of  an  association  of 
follicles,  terminating  on  the  free  surface  by  twelve  or  fifteen 
ducts,  through  which  the  secretion  is  passed  for  the  lubrication 
of  the  fauces.  These  follicles  are  bound  together  with  a  rather 
loose  areolar  tissue,  and  the  whole  is  invested  by  a  reticulated 
fibrous  capsule,  and  covered  externally  by   mucous  membrane. 

fourteen  ounces;  Tincture  Gollinsonia  Canadensis  three  fluid  ounces; 
Tincture  Stillingia  half  fluid  ounce;  Tincture  Capsicum  thirty  drops; 
Essence  of  Peppermint  thirty  drops. 

Add  the  tinctures  to  a  few  drachms  of  the  sugar  and  evaporate,  then 
mix  all  the  ingredients  and  triturate  thoroughly;  add  of  boiling  water 
two  and  a  half  ounces;  mix  and  work  well  in  the  mortar,  and  set  aside 
(bottom  upward  to  prevent  evaporation)  for  twenty-four  hours,  to  allow 
the  water  to  soften  and  incorporate  with  the  gum  and  sugar.  Cut  out 
slices,  flatten  out  with  a  roller  on  a  pill  tile  to  a  uniform  thickness,  using 
sugar  of  milk  or  starch  powder  to  prevent  the  mass  from  adhering  to  the 
tile  and  the  roller,  and  the  lozenges  to  each  other.  Cut  out  the  lozenges 
with  a  flaring  tin  punch,  a  full  half  inch  in  diameter,  so  the  lozenge  will 
weigh  eight  grains.  Let  them  dry  until  hard  before  using.  Avoirdupois 
weight  is  used. 


254  DISEASES   OF^  CHILDREN. 

The  structure  is  such  as  to  permit  very  great  variations  in  size. 
Thus,  in  simple  congestion,  they  may  attain  a  size  three  or  four 
times  as  large  as  in  the  normal  state,  and  under  inflammatory 
action  with  exudation,  their  bulk  is  still  further  increased.  The 
looseness  of  the  tissue  likewise  permits  organized  exudative 
material  to  once  or  twice  the  usual  size  of  the  organ,  without 
materially  interfering  with  their  function,  as  we  see  in  protracted 
cases  of  tonsillitis. 

Symptoms. — Quinsy  usually  manifests  itself  first,  by  soreness 
and  stiffness  of  the  throat,  with  difficult  deglutition,  and  more  or 
less  derangement  of  the  digestive  functions ;  occasionally  it  is 
ushered  in  with  a  marked  chill,  followed  by  febrile  reaction. 
There  is  always  some  fever,  dryness  and  constriction  of  the  skin, 
and  general  arrest  of  secretion.  In  a  few  hours  the  patient  com- 
plains of  pain,  and  a  sensation  as  if  some  foreign  body  were 
present  in  the  throat,  with  heat  and  constant  desire  to  swallow. 
When  fully  developed,  deglutition  becomes  so  difficult  and  painful 
as  to  occasion  extreme  suffering,  and  in  some  cases  it  is  impossi- 
ble. A  guttural  cough  with  frequent  desire  to  remove  the  secre- 
tion from  the  throat ;  a  hoarse  and  difficult  respiration,  and 
confused  whispering  and  guttural  articulation,  or  sometimes 
entire  loss  of  voice,  is  observed.  In  the  severer  cases  it 
becomes  impossible  for  the  patient  to  lie  down,  and  in  many,  but 
little  rest  is  obtained  in  consequence  of  the  difficult  respiration 
when  the  will  is  in  abeyance.  If  we  examine  the  throat  in  this 
disease,  we  will  find  the  tonsils  enlarged  and  reddened ;  some- 
times so  large  as  to  entirely  close  the  opening  of  the  fauces. 

An  attack  of  quinsy  continues  for  a  variable  length  of  time; 
usually  from  four  to  twenty  days,  and  terminates  sometimes  by 
resolution,  at  others  by  suppuration.  When  it  terminates  the 
latter  way,  the  gland  rapidly  enlarges;  there  is  a  dull  throbbing 
pain  or  aching,  and  a  yellowish  color  near  where  the  pus  points; 
usually  it  readily  comes  to  the  surface  and  discharges  without 
assistance,  but  sometimes  it  is  very  slow  and  requires  the  bistoury. 

A  condition  of  chronic  inflammation  and  enlargement  fre- 
quently continues,  in  those  predisposed  to  the  disease.  The 
glnnrls  appear  prominent  on  examination  ;  the  mucous  follicles 
eiilars::^^  ;  the  color  a  dusky-red,  and  considerabla  tenderness. 
Associated  with  this,  we  frequently  have  a  chronic  irritation  with 
determination  of  blood  to  the  entire  isthmns  of  the   fauces,  and 


TONSILLITIS.  255 

elongation  of  the  uvula,  giving  rise  to  a  continuous  disagreeable 
cougli,  derangement  of  the  general  health,  finally  inducing  seri- 
ous disease  of  the  respiratory  apparatus. 

Diagnosis. — The  diagnosis  is  very  readily  effected,  as  the 
symptoms  pointing  to  disease  of  the  throat  are  so  prominent  as 
to  lead  to  its  examination  at  once.  Upon  depressing  the  tongue 
one  or  both  tonsils  will  be  seen  enlarged  and  reddened.  Day  by 
day  we  find  the  swelling  increasing,  until,  if  both  tonsils  are 
engaged  in  the  disease,  they  will  have  quite  closed  up  the  isthmus 
of  the  fauces.  The  deep,  throbbing  pain  in  the  part,  greater 
difficulty  of  respiration  and  deglutition,  with  yellowish  discolora- 
tion, give  information  of  the  establishment  of  suppuration. 

Prognosis. — Though  these  symptoms  are  sometimes  very 
urgent,  and  the  patient  suffers  extremely  from  a  sense  of  im- 
pending suffocation,  not  one  in  a  thousand  will  die  of  the  disease. 
Yet  it  has  been  one  peculiarly  difficult  to  influence  with  reme- 
dies; and  the  radical  cure  of  the  disease,  where  there  has  been  a 
predisposition  to  it,  has  been  considered  impossible,  except  by 
total  ablation. 

Treatment. — The  use  of  Aconite  with  the  spray  instrument 
is  almost  specific  in  the  early  stage  of  the  disease.  I  have  em- 
ployed the  steam  atomizer,  but  the  Bergsen  tubes  operated  with 
the  rubber  bellows,  the  Richardson  apparatus  in  its  many  modified 
forms,  will  answer  the  purpose,  or  the  small  Essex  spray  is  very 
good.  With  the  steam  atomizer  I  use  it  in  the  proportion  of 
gtt.  XX.  to  water  5ij-,  with  the  air  spray  gtt.  x.,  to  water  5iv. 
The  spray  is  used  as  often  as  every  four  hours,  for  five  minutes 
at  a  time,  until  relief  is  obtained.  In  many  cases  I  have  suc- 
ceeded in  arresting  the  disease  with  the  one  application.  It  is 
well  to  have  the  patient  spit  out  the  Aconite  that  accumulates  in 
the  mouth,  as  there  will  be  too  much  to  swallow. 

When  these  instruments  are  not  at  hand,  let  the  patient  inhale 
the  vapor  of  vinegar  and  water,  and  apply  to  the  throat  the 
Linaraentum  Stillingia  on  flannel.  The  internal  remedy  in  this 
case  will  be  Aconite  alone,  using  it  in  the  usual  proportion,  and 
repeating  it  every  hour.  There  is  no  doubt  about  the  specific 
action  of  the  remedy,  even  when  taken  in  these  small  doses, 
thougli  it  is  not  so  certain  as  when  used  with  the  spray.  Some- 
times Phytolacca,  Belladonna  or  Rhus  may  be  added  to  the  sed- 


256  DISEASES   OF   CHILDREN. 

ative.  If  the  tongue  is  red  aud  dirty,  aud  tlie  tissues  of  the 
throat  red  and  relaxed,  sulphurous  acid  is  a  very  good  remedy. 

Penciling  the  tonsils  with  the  strong  tincture  of  Veratrum 
will  also  exercise  a  marked  influence  on  the  inflammation,  and 
will  sometimes  arrest  it  at  once. 

These  means  should  be  persisted  in,  and  if  they  do  not  arrest 
the  inflammation  they  will  most  frequently  prevent  suppura- 
tion. When  they  prove  ineffectual,  I  am  satisfied  that  there  are 
no  means  which  would  have  given  better  results,  and  we  wait 
the  result  of  suppurative  action  with  patience.  Much  relief  is 
now  given  by  the  use  of  inhalations,  and  sometimes  by  hot 
fomentations  applied  to  the  throat.  As  a  general  rule  the  abscess 
will  open  itself,  and  this  we  would  always  prefer  in  children.  If 
it  does  not,  and  the  symptoms  of  obstruction  in  the  throat  be- 
come alarming,  we  will  have  to  lance  the  tonsils.  This  is  not 
very  easily  done,  but  by  guarding  the  bistoury  with  the  finger, 
it  may  be  accomplished  without  danger. 

The  treatment  for  the  radical  cure  of  the  disease  will,  vary  in 
different  cases.  If  the  tonsils  alone  are  affected,  the  general 
health  being  good,  I  think  we  may  hope  for  a  cure  in  the  child. 
For  this  I  rely  principally  upon  the  local  application  of  persul- 
phate of  iron  ;  at  first  one  part  to  three  of  glycerine,  but  increas- 
ing its  strength  as  the  treatment  progresses,  until  it  is  used  of 
full  strength  if  necessary.  The  continued  use  of  the  tincture  of 
Hamamelis,  applied  to  the  tonsils  once  or  twice  daily,  will  also 
give  good  results.  If  there  is  disease  of  adjacent  parts,  the 
treatment  advised  in  chronic  pharyngitis  will  be  used  in  addition. 

When  these  means  fail,  we  will  have  to  take  into  consideration 
the  propriety  of  excision.  It  is  claimed  by  some,  that  the  remo- 
val of  the  tonsils  leads  to  tuberculosis  of  the  lungs,  and  this 
claim  is  based  upon  considerable  experience  in  sections  of  coun- 
try where  tonsillitis  prevails.  Why  such  a  result  should  follow 
I  can  not  see. 

The  tonsils  are  removed  with  a  tonsiUitome,  or  guillotine,  and 
is  easily  effected,  and  without  risk.  The  important  part  of  the 
operation  is  to  include  the  whole  of  tonsil  in  the  ring  of  the 
instrument,  so  as  to  remove  it  when  the  knife  is  thrown  forward. 
If  not  wholly  removede,  the  disease  may  be  reproduced,  just  as 
if  nothinoj  had  boon  done.  If  there  should  be  hemorrhage  fol- 
lowiufj  tlio  oporation,  pencil  the  part  with  persulphate  of  iron, 
or  a  saturated  solution  of  alum. 


CROUP.  257 

CROUP. 

Croup  is  laryngitis  of  the  child,  and  yet  it  differs  very  mate- 
rially from  that  disease  in  the  adult.  This  difference  is  owing 
in  part  to  the  imperfect  development  of  the  larynx  in  the  child, 
as  compared  with  the  adult,  and  to  a  limited  extent,  the  differ- 
ence in  the  progress  and  results  of  the  inflammatory  action. 
Thus  it  is  well  to  retain  the  name  of  eroup  for  the  laryngeal 
affection  of  the  child,  to  prevent  confounding  the  disease  with 
the  laryngitis  of  the  adult. 

We  recognize  three  forms  of  croup,  mucous,  pseudo-viembra- 
nous,  and  spasmodic.  Though  alike  in  some  of  their  features 
and  symptoms,  it  is  well  to  study  them  separately. 

MUCOUS    CROUP. 

This  is  the  most  common  form  of  the  disease  in  our  western 
country,  comprising,  probably,  two-thirds  of  all  the  cases  met 
with.  It  varies  in  intensity  in  different  localities,  at  different 
seasons,  and  in  different  persons.  Thus  in  some  places  it  is  a 
very  common  disease,  in  the  late  autumn  and  early  winter,  and 
in  the  spring,  when  winter  is  breaking  up  ;  as  on  the  shores  of 
Lake  Erie.  While  in  some  other  sections  croup  is  rarely  seen, 
as  in  Cincinnati  away  from  the  river. 

Causes. — The  cause  of  this,  as  well  as  other  forms  of  croup  is 
cold,  with  its  arrested  secretion  and  derangement  of  the  circula- 
tion. Why  it  should  particularly  affect  the  small  surface  of 
mucous  membranes  lining  the  larynx,  we  are  unable  to  say,  as 
we  are  unable  to  account  for  many  things  we  meet  with  in  the 
study  of  medicine. 

Pathology. — This  is  a  true  inflammation  of  the  mucous 
membrane  of  the  larynx,  though  not  of  an  active  character.  It 
is  sufficient,  however,  to  cause  an  increased  circulation  of  blood 
to  it,  some  impairment  of  the  capillary  circulation,  and  an  in- 
creased activity  of  the  raucous  follicles.  It  might  properly  be 
termed  follicular  laryngitis. 

There  is  but  little  thickening  of  the  mucous  membrane ;  in- 
deed, all  there  is  depend^   upon   the  increased  distension  of  the 

blood-vessels.     We   have,  therefore,  to  look  somewhere  else  for 
17 


258  DISEASES  OF   CHILDREN. 

the  cause  of  the  difficult  breathing,  which  is  so  prominent  a 
symptom.  This  is  partly  owing  to  accumulations  of  mucus  in 
the  larynx,  but  principally  to  contraction  of  the  intrinsic  muscles 
of  the  organ,  from  the  irritation  of  the  raucous  membrane. 

Thus  post-mortem  examination  does  not  show  the  larynx 
occluded  by  structural  change,  as  many  would  suppose.  In 
some  cases,  it  is  true,  there  are  considerable  accumulations  of 
mucus,  but  in  most  the  larynx  is  sufficiently  free  for  respiration, 
and  we  must  conclude  that  the  child  has  been  asphyxiated  by 
the  spastic  contraction  of  the  laryngeal  muscles. 

Symptoms. — Frequently  for  a  day  or  two  before  the  attack 
the  child  will  have  had  symptoms  of  cold,  with  a  slight  cough. 
Both  the  cough  and  voice  are  frequently  a  little  hoarse  and  rough, 
and  would  be  recognized  by  a  person  acquainted  with  the  dis- 
ease as  croupal. 

The  attack  of  croup  occurs  most  frequently  at  night,  though 
it  may  be  in  the  day  time.  The  child  seems  to  be  suffering  more 
with  its  cold  during  the  evening,  but  still  it  is  not  sick,  and  it  is 
put  to  bed  without,  probably,  a  thought  of  danger.  But  along 
about  the  middle  of  the  night  the  parents  are  aroused  by  the 
child  starting  out  of  sleep  with  difficult  respiration,  a  hoarse 
voice,  and  a  croupal  cough. 

The  respiration  is  rough  and  whistling,  the  cry  hoarse  and 
feeble,  except  when  a  great  effort  is  made,  when  it  becomes  shrill 
and  piping.  At  first  the  difficulty  of  respiration  is  intermittent, 
but  after  an  hour  or  two  it  becomes  permanent,  and  there  is  a 
peculiar  whistling  or  gurgling  sound  as  the  air  passes  into  and 
out  of  the  larynx. 

As  the  disease  progresses  the  difficulty  of  respiration  becomes 
more  marked,  and  the  cough  is  hoarser,  has  a  peculiar  metallic 
tone,  and  the  voice  sinks  to  a  whisper.  If  the  child  sleeps  mucus 
accumulates  in  the  throat,  the  breathing  becomes  more  and  more 
difficult,  until  at  last  the  child  wakes  with  symptoms  of  asphyxia. 
At  first  the  skin  is  dry,  its  temperature  increased  and  the  pulse 
full  and  hard.  But  as  the  respiration  becomes  more  difficult,  a 
cold  clammy  perspiration  breaks  out,  the  extremities  become  cold, 
and  the  pulse  frequent  and  feeble.  The  disease  runs  its  course 
in  from  twelve  to  twenty-four  hours,  terminating  in  a  subsidence 
of  the  disease  or  death. 


CBOUP.  259 

Diagnosis. — The  hoarse  metallic  (croupal)  cough,  with  hoarse- 
ness and  change  of  voice  is  sufficient  evidence  of  croup,  but  it 
does  not  inform  us  which  of  the  three  varieties  it  is.  In  mucous 
croup,  there  is  the  slight  febrile  action  to  distinguish  it  from  the 
spasmodic  variety,  and  the  evident  presence  of  mucus  in  the 
larynx  manifested  by  the  rattling  sound  heard  on  auscultation, 
and  when  the  patient  coughs,  which  distinguishes  it  from  the 
pseudo-membranous  form.  The  evidence  of  increased  secretion 
of  mucus  in  the  throat  is  the  diagnostic  feature  of  this  disease, 
though  other  points  of  distinction  will  be  named  when  we 
describe  the  two  other  forms. 

Peognosis — Though  some  cases  of  mucous  croup  are  very 
severe,  and  require  careful  and  close  attention,  yet  we  may 
regard  the  prognosis  as  favorable.  I  do  not  think  the  mortality 
should  exceed  from  two  to  five  per  cent. 

Treatment. — Three  methods  of  treatment  may  be  pursued, 
and  either  of  them  will  give  success  if  properly  carried  out;  or, 
if  the  practitioner  chooses,  he  may  take  a  part  of  each  and  form 
his  own  treatment  out  of  it. 

I  may  premise  by  saying  that  the  treatment  generally  adopted, 
of  giving  emetics  for  the  purpose  of  emesis,  is  the  worst  that 
could  possibly  be  done,  if  we  except  the  insane  idea  of  the  local 
application  of  nitrate  of  silver,  by  the  followers  of  Dr.  Green. 
It  makes  very  little  difference  what  emetic  agents  are  employed, 
if  the  object  is  speedy  vomiting ;  for  such  action  is  not  attended 
with  relaxation  or  sedation  in  one-half  the  cases,  while  the 
efforts  at  vomiting  throw  the  larynx  into  action,  cause  increased 
determination  of  blood,  and  increased  irritation  of  the  intrinsic 
muscles.  There  is  no  more  certain  way  to  destroy  the  life  of 
the  child  than  this. 

Emetic  agents,  however,  may  be  used  in  the  treatment  of  croup 
with  success,  and  we  will  consider  this  use,  as  the  first  plan.  The 
objects  we  wish  to  accomplish  are:  first,  relaxation  of  the  larynx 
to  give  better  respiration  ;  second,  to  produce  sedation,  and  thus 
lessen  inflammatory  action ;  third,  to  increase  secretion  and 
thereby  get  a  material  less  tenacious  and  more  easily  removed, 
and  at  the  same  time  deplete  the  engorged  vessels  of  the  part. 
For  this  purpose  they  should  be  used  in  small  dosos  frequently 
repeated,  so  as  to  produce  nausea  and  its  effects — relaxation  and 


260  DISEASES   OF   CHILDREN. 

sedation — without  emesis.  I  prefer  preparations  of  Lobelia,  but 
other  nauseant  emetics  may  be  used  with  good  results.  The 
acetous  emetic  tincture  of  our  Dispensatory  will  be  found  to  ful- 
fill all  the  indications. 

Aconite  alone  is  the  principal  internal  remedy  in  the  second 
plan  of  treatment.  I  have  no  doubt  of  its  specific  action  in  this 
case,  even  in  small  doses.  I  would  prescribe  it  in  the  propor- 
tion of:  ^i  Tincture  of  Aconite  gtts.  j.  to  iij.,  water  Siv.,  a 
teaspoonful  every  fifteen  minutes.  Veratrura  may  be  used  in 
some  cases  in  the  proportion  of  gtt.  v.  to  gtt.  x.,  to  water  §iv., 
and  alternated  with  the  Aconite. 

The  external  remedy  in  this  case,  as  well  as  in  the  others,  is 
the  application  of  the  Stillingia  liniment  to  the  throat  over  the 
larynx.  It  may  be  applied  with  the  finger  or  a  piece  of  soft 
flannel  or  cotton,  and  the  application  repeated  every  half-hour 
or  hour.  In  some  cases  this  remedy  locally  applied  is  all-suffi- 
cient for  a  cure,  and  relief  will  be  noticed  within  an  hour. 
Occasionally  we  administer  it  internally  in  doses  of  half  a  drop 
to  one  drop  on  sugar;  it  may  be  repeated  every  half-hour  or 
hour.  In  families  where  croup  is  of  frequent  occurence,  it  is 
well  that  the  mother  should  have  a  bottle  of  Stillingia  liniment, 
and  be  instructed  to  use  it  on  the  first  appearance  of  hoarseness. 
The  formula  for  this  preparation  will  be  found  in  the  first  part. 
I  greatly  prefer  the  second  plan  of  treatment. 

When  the  breathing  is  very  difficult,  hot  water  may  be  applied 
to  the  throat  with  flannel  cloths  assiduously,  until  relief  is 
obtained.  This  part  of  the  treatment  is  of  much  importance, 
and  requires  that  the  application  of  heat  be  constant,  and  that 
the  surface  is  not  allowed  to  be  chilled  by  exposure  as  the  cloths 
are  changed,  or  by  wetting  the  clothing. 

The  third  plan  of  treatment  is  by  the  use  of  inhalations,  the 
vapor  of  water  or  vinegar  being  the  basis,  and  medieated  as  the 
case  seems  to  demand.  The  steam  spray  apparatus  is  an  ex- 
cellent instrument  for  using  inhalations  in  tliis  case,  though  if  it 
is  not  at  hand  we  may  improvise  our  means  from  a  tin  vessel 
containing  the  fluid,  and  a  hot  iron  to  raise  the  vapor.  With 
the  spray  apparatus  I  use  the  preparation  of  Aconite,  named 
above  for  internal  use,  or  equal  parts  of  vinegar  and  water  in 
the  cup,  or  if  the  sounds  are  whistling,  lime  water.  The  ordi- 
nary inhalation  will  be  of  vinegar  and  water,  or  of  an  infusion 
of  hops  or  tansy. 


CROUP.  261 

With  either  of  these  means  the  hot  application  to  the  throat  is 
important.  Or,  when  it  can  not  be  conveniently  employed,  or 
we  are  afraid  to  trust  tlie  nurse,  we  will  apply  the  compound 
Stillingia  liniment,  or  in  place  of  this,  a  cloth  sufficiently  large 
to  cover  the  throat  and  upper  part  of  the  chest  is  spread  with 
lard  and  freely  sprinkled  with  the  compound  powder  of  Lobelia 
and  Capsicum,  and  applied.  The  old-fashioned  suufif  plaster, 
made  in  the  same  way,  answered  a  good  purpose. 

PSEUDO-MEMBRANOUS    CROUP. 

This  form  of  croup  is  fortunately  of  rare  occurrence,  as  it  is 
much  more  severe  than  the  others,  and,  if  not  treated  promptly 
and  skillfully,  will  terminate  fatally. 

Causes. — This  variety  is  produced  by  the  same  cause,  cold,  as 
the  other  forms,  though  there  is  some  difference  in  tlie  general 
health  of  the  patient,  which,  in  one  case,  gives  increased  secre- 
tion of  mucus,  and  in  the  other  a  plastic  exudation. 

Pathology. — This  is  a  true  inflammation  of  the  larynx,  com- 
ing on  gradually  and  progressing  slowly  in  the  majority  of 
cases,  and  attended  with  plastic  exudation  upon  the  mucous 
membrane.  In  this  case  we  find  the  mucous  membrane  no  more 
thickened  than  could  be  accounted  for  by  its  injection  with 
blood  ;  and  even  where  loosely  attached  there  is  no  submucous 
infiltration. 

Post-mortem  examination  shows  the  formation  of  a  false  mem- 
brane from  the  one-twelfth  to  the  one-sixth  of  an  inch  in  thick- 
ness. This  of  a  grayish-white  or  yellowish-white  color,  opaque, 
and  of  considerable  tenacity.  Microscopic  examination  shows  it 
to  be  composed  of  mucus,  epithelial  cells,  and  an  obscure  fibrous 
structure,  the  result  of  organization  of  the  plastic  exudation.  It 
varies  greatly  in  its  tenacity  of  adhesion  to  the  mucous  mem- 
brane;  in  some  cases  it  seems  almost  to  form  a  part  of  it,  and  is 
detached  with  great  difficulty  ;  in  others  it  is  very  loosely  attached, 
and  may  be  loosened  and  removed  by  simple  pressure  on  the  larynx 
externally.  In  a  large  majority  of  cases  this  false  membrane  is 
not  of  sufficient  thickness  to  account  for  the  arrest  of  the  respi- 
ratory function,  and  we  must  regard  the  spastic  contraction  of 
the  muscles  of  the  larynx,  from  irritation,  as  one  of  the  causes 
of  death. 


262  DISEASES  OP   CHILDEEX. 

Symptoms. — The  coming  ou  of  the  attack  of  pseudo-mera- 
brauous  croup  may  sometimes  be  recognized  for  three  or  four 
days,  or  even  a  week.  The  child  does  not  seem  sick,  and  is 
playing  about  the  house  as  usual,  but  has  some  cold,  and  the 
parents  notice  a  slight  hoarseness  of  voice  and  cough.  We  will 
notice,  however,  a  peculiar  metallic  resonance  to  the  voice,  cry, 
and  cough,  but  more  especially  that  there  is  a  dry  and  whistling 
respiration.  This  is  so  marked  that  the  breathing  may  be  heard 
across  the  room. 

The  attack  of  croup  most  frequently  comes  on  at  night,  as  in 
the  other  cases.  In  the  evening  it  is  noticed  that  there  is  more 
hoarseness  of  the  voice  and  the  cough  is  somewhat  croupal,  but 
as  the  child  breathes  pretty  well  and  does  not  seem  sick,  the 
parents  flatter  themselves  that  it  is  but  a  cold,  and  will  give  no 
trouble.  The  mother  has  told  me  of  going  to  the  child's  bed  or 
crib,  attracted  by  the  peculiar  whistling  respiration,  impressed 
that  there  was  something  wrong,  but  fearing  ridicule  if  she  sent 
for  the  physician. 

As  time  passes  the  child  becomes  restless  from  difficult  breath- 
ing, has  slight  attacks  of  cough  in  his  sleep,  which  are  clearly 
croupal.  In  another  hour  or  two  he  awakes  with  a  start  and 
assumes  a  sitting  position,  evidently  suffering  much  from  difficult 
respiration,  which  is  increased  by  the  attacks  of  coughing. 

The  symptoms  are  now  very  marked,  the  respiration  is  sibilant 
or  whistling,  and  difficult;  the  cough  hoarse  and  metallic;  the 
voice  roughened  or  sunk  to  a  whisper,  and  the  cry  shrill  and 
piping  ;  the  skin  is  dry,  the  pulse  hard  and  increased  in  fre- 
quency ;  urine  scanty,  and  the  patient  restless  and  uneasy. 

As  the  disease  progresses  there  is  a  gradual  increase  of  all 
these  symptoms,  but  especially  of  difficult  respiration,  which  is 
constant.  The  cough  is  spasmodic  in  its  character,  and  when  it 
comes  on  the  patient  suffers  very  greatly  from  want  of  air.  After 
a  time  evidences  of  asphyxia  appear  in  tlie  bluish  lips,  distended 
veins,  leaden  appearance  of  the  surface,  cold  extremities,  dullness 
of  the  nervous  system,  and  finally  coma  and  death. 

The  entire  duration  of  the  final  attack  will  be  from  six  to 
forty-eight  hours. 

Diagnosis.. — That  it  is  a  case  of  croup  is  evidenced  by  the 
peculiar  cough  and  the  change  of  the  voice  and  cry ;  that  it  is 
pseudo-membranous  croup  by  the  constantly  increasing  difficulty 


CROUP.  263 

of  respiration,  the  marked  dryness  and  sibilance  in  the  sound  of 
the  air  passing  through  the  larynx,  and  in  the  peculiarly  dry  and 
metallic  cough.  Dryness  and  metallic  resonance,  in  addition  to 
the  croupal  cough  and  voice,  are  the  diagnostic  points. 

Prognosis. — The  prognosis  is  not  as  favorable  as  in  the  other 
two  varieties,  and  with  the  best  treatment  some  cases  will  prove 
fatal.  Still  I  should  not  be  willing  to  indorse  the  old  state- 
ment— "a  large  majority  must  die" — but  think,  with  proper 
treatment,  the  majority  will  recover. 

Treatment. — The  indications  of  treatment  in  this  case  are : 
To  produce  relaxation  of  the  intrinsic  muscles  of  the  larynx, 
and  thus  give  freedom  to  the  respiration,  while  we  pursue  the 
main  treatment ;  to  lessen  inflammatory  action,  and  obtain  free 
secretion  of  mucus,  for  the  purpose  of  effecting  the  detachment 
of  the  false  membrane ;  and  finally  to  effect  the  removal  of  this. 

To  fulfill  the  first  indication,  we  employ  inhalations  of  the 
vapor  of  water,  or  water  and  vinegar  or  lime  water,  as  will  be 
hereafter  named.  With  this  we  direct  the  continuous  applica- 
tion to  the  throat  of  flannel  cloths  wrung  out  of  hot  water,  in 
the  meanwhile  bathing  the  throat  with  the  Compound  Stillingia 
Liniment.  These  are  important  means,  and  should  never  be 
neglected. 

There  are  two  plans  of  accomplishing  the  second  indication. 
The  one  is,  by  the  use  of  tincture  of  Veratrum  viride  or  Aconite, 
aided  by  inhalations  of  lime  water,  and  is  a  very  good  treatment 
and  much  pleasanter  than  the  use  of  nauseants.  I  prescribe  the 
Veratrum  in  the  proportion  of  gtt.  x.  to  water  5iv.,  a  teaspoou- 
ful  every  fifteen  minutes,  until  it  produces  a  marked  influence 
upon    the  pulse,   then    in    smaller  doses  to  continue   its   effect. 

Aconite  is  preferred  when  the  pulse  is  small  and  frequent,  and 
is  administered  in  the  usual  small  doses :  I|*  Tinct.  Aconite  gtt. 
ij.  water  5iv.,  a  teaspoonful  every  fifteen  minutes.  If  the  child 
is  very  sensitive  to  the  action  of  the  remedy  the  dose  should  be 
still  further  reduced,  and  if  we  find  the  lips  dry  and  contracted, 
and  the  child  grasping  at  the  mouth  with  its  hands,  it  should  be 
suspended  and  Veratrum  substituted. 

If  the  tongue  is  pallid  and  shows  small  spots  of  red,  Phyto- 
lacca may  be'combined  with  the  medicine.  If  the  little  patient 
is  dull  and  stupid  and  wants  to  sleep,  give  Belladonna.  If 
it  has  a  sharp  stroke  of  pulse,  and  moves  its  head  restlessly  back- 


264  DISEASES  OF   CHILDREN. 

ward  and  forward,  throwing  it  backwards  as  if  it  would  bury 
the  occiput  in  the  pillow,  give  it  Rhus.  This  remedy  is  also 
indicated  by  the  shrill  cry,  as  if  frightened,  and  sudden  starting 
from  sleep.  Gelseminum  is  indicated  by  tiie  flushed  face,  bright 
eyes,  and  contracted  pupils,  with  restlessness  and  great  irritation. 
These  remedies  are  secondary,  it  is  true,  but  it  is  a  case  that  re- 
quires all  that  we  can  do,  and  if  by  one  of  thes'e  we  strengthen 
the  Aconite  and  Veratrum,  we  give  our  patient  an  additional 
chance. 

What  the  physican  needs,  most  of  all,  is  a  steady  hand.  The 
treatment  requires  time,  and  we  must  not  get  excited.  If  the 
patient  is  growing  no  worse,  we  should  feel  satisfied  for  a  time ; 
if  there  is  but  a  slow  improvement,  as  marked  by  more  ease  of 
respiration,  a  better  circulation,  warmth  and  moisture  of  feet, 
legs  and  forehead,  we  will  feel  encouraged' and  hold  fast  to  the 
treatment. 

The  use  of  lime  water  as  an  inhalation  is  a  very  important 
part  of  this  treatment.  It  is  claimed  that  it  alone  is  sufficient 
to  arrest  the  inflammatory  action  and  cause  the  detachment  of 
the  membrane ;  and  I  have  employed  it  with  success  when  other 
means  have  failed.  The  Veratrum  and  Aconite  also  have 
proven  very  successful  alone,  and  they  will  fulfill  the  first  two 
indications. 

The  other  and  older  plan  of  treatment  is  by  the  use  of  the 
nauseant  emetics,  and  if  properly  used  will  give  excellent  re- 
sults. I  may  add,  that  if  improperly  used,  i.  e.,  so  as  to  irritate 
the  stomach  with  retching  and  inefi'ectual  efibrts  to  vomit,  they 
will  hasten  the  fatal  termination. 

Of  these  remedies  I  prefer:  I^  Acetous  Tincture  of  Lobelia, 
Acetous  Tincture  of  Sanguinaria,  aa.  5j-,  Molasses  5j-,  Chlorate 
of  Potash,  finely  powdered  5ss.,  let  them  be  combined  with  heat, 
and  add  the  potash.  "We  give  this  in  doses  of  a  teaspoonful 
every  ten  or  fifteen  minutes  until  nausea  is  induced,  then  in 
smaller  doses  so  as  to  continue  the  nausea  without  vomiting. 
The  greater  and  more  constant  the  nausea  without  efforts  at 
vomiting,  the  greater  the  success  of  the  treatment. 

Using  the  hot  applications  to  the  throat,  and  the  inhalations 
of  vinegar  and  water,  we  continue  the  nausea  for  some  hours,  at 
least  until  we  have  evidence  of  secretion,  and  the  commencing 
detachment  of  the  false  membrane.  This  will  readily  be  de- 
tected by  the  moist  sound  of  respiration,  and  a  gurgling  flapping 


CJROUP.  265 

sound  iu  the  act  of  coughing.  If  the  child  is  breathing  pretty 
freely,  we  may  wait  for  the  removal  of  the  membrane  by  the 
cough,  as  it  will  be  brought  away  by  shreds. 

But  if,  with  the  loosening  of  it,  it  seems  to  be  drawn  upward 
in  expiration,  and  downward  in  inspiration,  tending  to  block  up 
the  passages,  and  producing  evident  symptoms  of  asphyxia,  we 
carry  our  remedies  to  thorough  and  prompt  emesis.  Generally 
it  will  be  well  enough  to  prepare  an  infusion  of  the  compound 
powder  of  Lobelia  and  Capsicum  for  use  at  this  time,  as  we  will 
have  established  a  degree  of  tolerance  for  the  other  preparation. 
Occasionally  we  will  meet  with  a  case  requiring  prompt  relief. 
Here  the  child  may  be  turned  on  its  abdomen,  and  a  finger  in- 
troduced into  the  mouth,  drawing  the  tongue  forward  and  excit- 
ing the  fauces,  will  be  followed  by  a  forcible  expulsive  effort, 
and  the  membrane  will  be  detached.  A  case  of  this  kind  oc- 
curred in  my  practice — the  membrane  became  detached  and  en- 
tirely stopped  the  larynx,  the  child  was  asphyxiated  and  would 
have  died  in  five  minutes.  I  snatched  it  from  the  mother,  turned 
it  on  its  face,  inserted  my  finger  as  far  down  as  the  larynx ;  a 
forcible  effort  at  vomiting  ensued,  and  the  whole  membrane  was 
removed  at  once,  being  a  perfect  cast  of  the  larynx.  The  child 
recovered. 

Success  in  the  treatment  of  pseudo-membranous  croup,  what- 
ever means  may  be  pursued,  depends  upon  keeping  the  larynx 
relaxed  to  permit  aeration  of  the  blood,  until  in  the  course  of 
time  we  get  the  detachment  of  the  false  membrane.  It  demands 
patience  and  perseverance  in  the  use  of  the  means  named,  and 
success  will  follow. 

The  convalescence  of  such  a  case  demands  much  care,  as  the 
patient  will  have  suffered  from  imperfect  respiration,  from  the 
effects  of  the  remedies  employed,  and  the  larynx  and  other  mu- 
cous surfaces  will  be  in  a  debilitated  condition.  Put  the  patient 
upon  the  use  of  bitter  tonics,  as  :  It  Quinia,  Hydrastine,  an.  gr. 
vj.,  make  twelve  powders,  give  one  every  three  hours.  The  child 
should  be  kept  warm  and  quiet,  in  the  recumbent  position,  and 
guarded  from  draughts  of  air,  and  in  addition  it  should  be  kept 
free  from  excitement. 


266  DISEASES  OF  CHILDREN. 

SPASMODIC    CROUP. 

In  some  sections  of  country  this  is  the  common  form  of 
croup,  though  in  others  the  mucous  form  is  of  most  frequent 
occurrence.  It  is  not  so  severe,  and  ordinarily  patients  recover 
without  difficulty.  Very  rarely  a  case  is  met  with  running  to  a 
fatal  termination. 

Causes. — The  cause  of  this,  as  of  the  other  forms,  is  cold, 
sudden  change  of  temperature,  exposure  to  an  east  or  north 
wind,  sitting  in  a  draught,  irritation  of  the  digestive  apparatus,  etc. 

Pathology. — In  spasmodic  croup  there  is  irritation  of  the 
mucous  membrane  of  the  larynx  with  determination  of  blood,  or 
in  some  cases  a  slight  superficial  inflammation.  The  irritation  is 
sufficient  to  excite  spasmodic  contraction  of  the  muscles  of  the 
larynx,  hence  the  symptoms  of  croup.  In  many  cases  the  irrita- 
tion extends  to  the  bronchial  tubes  as  well,  and  they  are  more  or 
less  contracted.  Thus,  while  the  difficulty  of  breathing  is  prin- 
cipally laryngeal,  it  may  be  to  a  limited  extent  asthmatic. 

Symptoms. — In  this  case  there  is  usually  but  slight  symptoms 
of  cold  before  the  attack,  though  occasionally  the  child  will  have 
a  severe  cold.  Frequently  there  is  slight  hoarseness  in  the  even- 
ing and  a  little  cough,  though  not  sufficient  to  attract  attention. 
The  child  is  put  to  bed  and  sleeps  for  an  hour  or  two,  then  be- 
comes restless,  and  finally  wakes  with  a  start,  suffering  severely 
from  difficult  breathing. 

Now  the  breathing  is  stridulous,  the  cough  hoarse  and  croupal, 
the  voice  hoarse  or  whispering,  and  the  cry  shrill  and  piping. 
The  skin  is  soft  and  moist,  the  pulse  soft  and  regular,  and  the 
nervous  system  shows  no  traces  of  excitement.  In  a  few  minutes 
the  child  breathes  easier,  and  may  fall  asleep,  but  the  period  of 
ease  is  short,  a  paroxysm  of  cough  occurs,  and  the  breathing  is 
as  difficult  as  before.  Thus  the  disease  will  continue  for  hours, 
broken  up  into  exacerbations  and  remissions,  until  finally,  the 
paroxysms  becoming  lighter  and  lighter,  the  breathing  is  wholly 
relieved,  and  nothing  is  left  but  a  slightly  hoarse  cough. 

Diagnosis. — The  diagnosis  of  spasmodic  croup  may  be  easily 
made  if  we  notice,  first,  that  there  is  an  entire  absence  of  febrile 


CROUP.  267 

symptoms;  second,  that  it  is  remittent  in  character  and  broken 
up  into  exacerbations  and  remissions.  There  is  an  absence  of 
the  mucous  rattling,  as  in  mucous  croup,  and  the  extreme  dryness 
of  respiration  and  cough,  as  in  the  pseudo-membranous;  and 
neither  in  the  respiration  nor  cough  do  we  detect  any  evidences 
of  change  in  the  condition  of  the  raucous  membrane,  as  is  so 
distinct  in  the  other  two  forms.  On  the  contrary,  all  the  symp- 
toms point  to  irritation  of  the  intrinsic  muscles  of  the  larynx,  and 
the  consequent  diminution  of  its  calliber,  as  the  true  condition. 

Prognosis. — The  prognosis  is  favorable.  For,  while  in  ex- 
ceptional cases,  the  impairment  of  respiration  may  be  so  great  as 
to  destroy  life,  in  the  majority  recovery  would  occur  without  aid 
from  medicine. 

Treatment. — The  treatment  of  mucous  croup  may  be  em- 
ployed in  this  case,  especially  the  treatment  by  the  use  of  nau- 
seants.  I  prefer  preparations  of  Lobelia  to  any  other,  as  this  is 
our  most  powerful  anti-spasmodic.  The  compound  tincture  of 
Lobelia  and  Capsicum  (King's  Anti- spasmodic  Tincture)  is  a 
very  good  form,  but  almost  any  preparation  of  the  remedy  will 
answer.  It  should  be  given  in  doses  sufficiently  large  to  produce 
nausea,  but  always  short  of  emesis. 

In  the  milder  cases  the  administration  of  the  compound  tinc- 
ture of  oils  of  Lobelia  and  Stillingia  (Stillingia  liniment),  iu 
doses  of  one  drop,  repeated  every  quarter  or  half  hour,  with  its 
external  application  to  the  throat,  will  be  sufficient  to  arrest  the 
disease.  In  giving  this,  it  is  dropped  on  sugar,  which  is  allowed 
to  dissolve  in  the  mouth  and  swallowed  without  water.  This 
will  also  be  found  a  good  treatment  in  the  milder  cases  of  mucous 
croup,  or  in  its  earlier  stages.  In  families  where  the  children 
are  subject  to  croup,  it  will  save  much  trouble  to  provide  the 
mother  with  the  remedy,  with  directions  for  its  use.  It  will  save 
many  unpleasant  trips  at  night,  and  be  a  very  great  satisfaction 
to  the  parents. 

Spasmodic  croup  is  frequently  sympathetic,  and  repeated  at- 
tacks occur  much  to  the  surprise  of  the  physician.  There  is  an 
ir^ritation  of  the  stomach  requiring  treatment,  or  the  patient 
wants  sulphite  of  soda  or  sulphurous,  acid  to  remove  an  unpleas- 
ant coat  from  the  tongue,  (and  a  similar  unpleasantness  from 
the  stomach),  or  it  may  be  troubled  with  worms  and  require 
Santonine  with  Podophyllin. 


268  DISEASES   OF   CHILDREN. 

In  some  of  these  cases  the  disease  is  distiuctly  periodic,  and 
quinine  should  be  given  in  full  antiperiodic  doses.  In  other 
cases  the  reccurreuce  of  the  disease  is  prevented  by  the  adminis- 
tration of  Bromide  of  Ammonium  3ij.  water  ^ix.,  a  teaspoonful 
every  four  hours. 

In  still  other  cases  the  croup  is  the  result  of  a  suppressed 
eruption,  frequently  urticaria  or  hives,  or  it  may  arise  from  retro- 
cession of  an  eruption,  and  erythema,  roseola,  or  even  that  which 
is  popularly  known  as  heat.  These  cases  will  be  reached  by  the 
administration  of  small  doses  of  Aconite  with  Belladonna,  and 
sometimes  by  sponging  the  surface  with  hot  water. 


(EDEMA  GLOTTIDIS. 

CEdema  glottidis,  or  a§thenic  laryngitis,  may  occur  at  any  age, 
but  is  most  frequent  in  childhood.  It  is  not  met  with  very  fre- 
quently ;  indeed^  many  physicians  will  practice  a  life-time  without 
seeing  a  case. 

Causes. — This  disease  seems  to  be  dependent  upon  cold,  but 
why  it  should  invade  this  particular  part  we  are  unable  to  tell. 
As  it  occurs  in  feeble  children,  and  therein  manifesting  a  ten- 
dency to  disease  of  the  throat,  it  is  probably  owing  to  debility 
of  the  tissues. 

Pathology. — The  disease  is  undoubtedly  inflammatory  in  its 
character,  but  the  inflammation  is  subacute,  and  involves  the 
submucous  tissue.  In  its  progress  there  is  effusion  into  this,  and 
it  becomes  swollen,  and  where  this  tissue  is  loose,  as  the  inward 
surface  of  the  epiglottis,  and  the  upper  portion  of  the  larynx,  it 
produces  such  engorgement  as  to  obstruct  the  passage  of  air. 
As  this  distension  is  greatest  in  the  epiglottis,  the  difficulty  is 
much  greater  in  inspiration  than  in  expiration. 

Symptoms. — The  disease  commences  with  a  continually  in- 
creasing impediment  to  respiration,  and  a  feeling  of  fullness  and 
constriction,  and  continuous  desire  to  clear  tlie  throat,  as  if  the 
irritation  were  caused  by  some  foreign  body.  The  voice  becomes 
hoarse,  then  croupal,  and  afterward  sharp,  stridulous,  whispering, 
and  is  then  lost  entirely.  There  is  a  hoarse,  convulsive  cough, 
with  fits  of  suffocation,  causing  great  agony. 


(EDEMA   GLOTTIDIS.  269 

The  most  marked  feature  of  the  disease  is,  that  while  inspira- 
tion is  prolonged,  stridulous,  and  exceedingly  difficult,  expiration 
is  comparatively  easy.  This  feature  is  so  constant  as  to  be  path- 
ognomonic. 

There  is  no  fever,  but  as  the  disease  progresses  the  pulse  be- 
comes more  frequent,  small,  and  irregular.  The  difficulty  of 
breathing  increases,  the  paroxysms  of  coughing  and  siiffi^cation 
are  more  frequent,  symptoms  of  asphyxia  appear,  the  cerebral 
functions  are  disturbed,  and  at  last  death  ensues  from  inability  to 
inflate  the  lungs. 

Diagnosis. — The  diagnosis  in  this  disease  will  be  readily 
made,  if  it  is  recollected  that  the  difficulty  is  in  inspiration,  while 
expiration  is  comparatively  free.  In  the  later  stages  of  the  dis- 
ease, when  it  is  likely  to  prove  fatal,  the  diagnosis  will  be  more 
difficult. 

Progxosis. — In  the  early  stages  of  the  disease,  the  prognosis 
is  favorable ;  but  when  symptoms  of  asphyxia  begin  to  appear, 
it  is  doubtful. 

Treatment. — The  treatment  of  this  case  will  be  wholly 
diffi-rent  from  that  adopted  in  croup,  being  stimulant  instead  of 
relaxing.  We  would  dry  cup  the  throat  and  upper  part  of  the 
back,  and  repeat  it  if  the  case  was  serious;  applying  to  the 
throat  and  breast  a  cloth  spread  with  lard  and  sprinkled  with 
the  compound  powder  of  Lobelia  and  Capsicum,  changing  it  two 
or  three  times  daily.  A  mustard  foot-bath  may  be  used  with 
good  effiict,  and  repeated  two  or  three  times,  following  it  by  the 
application  of  dry  heat.  We  guard  against  coldness  of  the  ex- 
tremities, which  so  frequently  follows  the  ordinary  use  of  the 
foot-bath,  and  which  almost  invariably  increases  the  disease. 

If  the  pulse  is  frequent  and  small,  we  will  give  Aconite,  com- 
bining with  it  Apocynum,  as:  It  Tinct.  Aconite  gtt.  ij.  to  gtt. 
v.,  Tinct.  Apocynum  gtt.  iij.  to  gtt.  xv.,  water  .51  v.,  a  teaspoonful 
every  hour.  Apocynum  will  act  upon  the  bowels  in  quite  small 
doses,  but  if  the  bowels  are  torpid  the  proportion  of  this  remedy 
may  be  increased.  Phytolacca  is  sometimes  indicated  by  the 
soreness  of  the  mouth  and  throat,  and  engorgement  of  the  lym- 
phatic glands.  Belladonna  is  a  good  remedy  in  some  cases,  the 
indication  being  the  dullness  and  stupor,  and  inclination  to  sleep. 

In  some  cases  stimulant  doses  of  Lobelia,  with  some  pleasant 


270  DISEASES  OF  CHILDREN. 

aromatic  to  prevent  nausea,  may  be  prescribed.  The  following 
formula  answers  well :  ^  Tincture  of  Lobelia  oij-,  Compound 
Tincture  of  Lavender  fSss.,  Simple  Syrup  to  Sij.;  a  teaspoouful 
every  hour,  or,  better,  half  teaspoonful  every  half  hour.  If  at 
any  time  it  should  produce  nausea  the  dose  must  be  lessened. 

This  may  be  aided  by  the  use  of  stimulant  inhalations  with  the 
spray  apparatus.  A  very  good  inhalation  may  be  formed  by 
adding  Carbolic  Acid,  grs.  v.,  to  water  Siv.,  or,  Hydrochlorate 
of  Ammonia,  grs.  x.,  to  water  5iv.;  or  in  place  of  them,  lime 
water,  of  full  strength,  may  be  employed.    • 

Associated  with  these  means,  in  a  malarial  country  we  would 
give  quinine  in  stimulant  doses,  say  half  to  one  grain  every  three 
hours.  It  may  be  given  alone,  or,  what  is  better,  associated  with 
hydrastine. 

Sometimes  we  find  a  very  troublesome  cough,  that  greatly  in- 
creases the  patient's  danger,  by  its  interference  with  the  respira- 
tory movement.  "Without  the  cough  the  child  would  get  a  suffi- 
cient supply  of  air,  and  its  blood  would  be  decarbonized ;  with 
the  cough  it  suffers  from  defective  oxygenation  and  retained  car- 
bonic acid.  In  this  case  the  life  of  the  patient  may  depend  upon 
quieting  the  cough.  For  this  purpose  I  would  make  the  follow- 
ing prescription :  IB^  Sulphate  of  Morphia  gr.  j..  Alum  5ss., 
Gum  Arabic,  White  Sugar,  aa.  3i- ;  mix  and  divide  in  twenty 
parts.  One  of  these  may  be  placed  upon  the  tongue,  and  allowed 
to  dissolve,  and  be  swallowed  without  taking  fluid,  and  repeated 
as  often  as  may  be  necessary  to  quiet  the  irritation. 

BRONCHIAL    CATARRH. 

This  is  one  form  of  cold — that  in  which  it  principally  affects 
the  bronchial  tubes — as  in  nasal  catarrh  it  is  principally  confined 
to  the  cavities  of  the  nose.  It  is  of  frequent  occurrence  in  the 
fall  and  early  winter,  and  in  the  changeable  weather  of  spring. 
Sudden  changes  of  temperature,  or  the  barometric  condition  of 
the  atmosphere,  is  a  very  common  cause.  Exposure  to  north  or 
east  winds,  or  too  long  or  great  exposure  in  cold  weather,  will 
also  cause  it. 

Pathology. — The  disease  varies  from  simple  irritation  with 
determination  of  blood,  to  a  slight  grade  of  inflammatory  action. 
In  all  cases  there  is  a  stage  in  which  secretion  is  arrested.     This, 


BRONCHIAL   CATARRH.  271 

however,  is  short,  and  whea  the  patient  is  seen  by  the  physician, 
increased  secretion  is  a  present  condition. 

Symptoms. — The  child  manifests  the  usual  symptoms  of  cold, 
and  in  addition  has  a  cough,  with  some  difficulty  of  respiration. 
It  is  noticed  that  it  does  not  feel  so  well  .as  common,  that  it  does 
not  move  freely,  or  if  eating,  that  its  appetite  is  impaired.  There 
is  always  more  or  less  febrile  action  for  two  or  three  days,  and 
sometimes  the  fever  is  so  prominent  for  a  day  or  two  that  it  ob- 
scures the  symptoms  of  local  disease. 

The  physician  notices  in  addition  to  all  this,  that  there  is  a 
want  of  free  respiratory  movement,  and  an  unnatural  rattling 
sound  in  respiration.  On  auscultation  we  find  the  evidence  of 
increased  mucous  secretion  over  all  parts  of  the  chest,  in  the 
moist  blowing  sound  (mucous  rhonchus). 

After  the  third  or  fourth  day,  the  febrile  action  passes  away, 
the  difficulty  of  breathing  goes  with  it,  leaving  but  the  cough, 
and  increased  secretion,  which  gradually  declines  until  in  from 
ten  days  to  two  weeks,  it  has  wholly  disappeared. 

Treatment. — In  the  earlier  stage  of  the  disease  we  give 
Aconite  or  Veratrum,  according  as  the  pulse  is  small  or  full, 
with  such  other  remedies  as  may  be  indicated.  If  the  patient 
seems  to  have  pain  in  the  chest,  on  coughing  or  in  respiration, 
Bryonia  is  suggested.  If  the  pulse  is  sharp,  and  there  is  rest- 
lessness with  sudden  starting  in  sleep,  the  remedy  will  be  Khus. 
If  there  is  much  mucous  secretion,  and  rattling  in  bronchial 
tubes,  with  suppressed  breathing.  Lobelia  is  added  to  the  seda- 
tive. In  some  cases  the  old  prescription — I^  Tinct.  Lobelia  3jv 
Comp.  Tinct.  Lavender  5iij-,  Simple  Syrup  Sjss. — is  a  most  excel- 
lent remedy ;  it  can  be  given  in  small  doses,  frequently  repeated, 
just  short  of  nausea,  until  the  patient  is  relieved. 

If  there  is  much  oppression  of  the  chest  with  difficult  respira- 
tion, use  the  cloth  spread  with  lard,  and  sprinkled  with  the 
compound  powder  of  Lobelia  and  Capsicum,  applying  it  to  the 
entire  anterior  and  lateral  walls  of  the  chest,  and  changing  two 
or  three  times  a  day. 


272  DISEASES   OF   CHILDREN. - 

ASTHENIC    BRONCHITIS. 

A  form  of  bronchial  disease  is  met  with  in  young  children, 
which  we  have  been  accustomed  to  describe  under  this  head, 
though  it  does  not  express  the  conditions  as  well  as  we  would 
wish. 

Causes. — The  exciting  cause  of  the  disease  is  cold,  from  ex- 
posure, from  sudden  changes  of  temperature,  or  of  the  hygro- 
metric  condition  of  the  atmosphere.  The  predisposing  causes 
are  such  as  impair  the  general  health  of  the  patient :  bad  air, 
insufficient  diet,  want  of  cleanliness  and  the  condition  heretofore 
described  under  the  head  of  dyscrasiafi — bad  blood  and  imperfect 
nutrition.  Though  the  disease  most  frequently  occurs  in  such 
persons,  it  will  occasionally  be  met  witTi  in  children  who  have 
been  healthy,  and  who  have  all  the  care  and  comforts  that  can 
be  given  them. 

Pathology. — The  inflammation  of  the  bronchial  mucous 
membrane  is  of  a  low  grade,  and  is  followed  by  relaxation  and 
a  sluggish  circulation  with  increased  secretion.  It  is  this  loss  of 
irritability  of  the  bronchial  muscular  fiber,  with  the  greatly  in- 
creased secretion,  that  is  the  principal  source  of  danger. 

Symptoms. — This  is  the  peripneumonia  notha  of  authors,  and 
generally  occurs  in  very  young  or  old  persons,  or  in  those  of 
exhausted  constitution,  or  who  have  been  liable  to  coughs  with 
profuse  watery  expectoration.  It  usually  commences  with  symp- 
toms of  cold  and  oppression  in  the  chest,  with  slight  febrile 
reaction.  The  cough  is  severe,  occurring  in  paroxysms;  the 
breathing  is  oppressed,  laborious  and  wheezing;  the  expectora- 
tion, scanty  at  first,  soon  becomes  abundant,  thin  and  frothy ; 
the  pulse  is  quick,  small,  and  irregular,  the  heat  of  the  surfiice 
but  little  if  any  increased,  the  extremities  generally  being  cool  ; 
the  tongue  is  loaded  with  a  foul,  dirty  mucus,  the  appetite  is 
gone,  and  the  bowels  constipated  at  first,  become  irregular  as  the 
disease  advances.  As  the  disease  becomes  more  intense,  the 
ooniitonanee  is  pale  and  anxious,  there  are  exacerbating  fits  of 
dyspnoea,  in  wliioh  it  seems  almost  impossible  for  the  ])atient  to 
broatlie,  and  if  the  patient  attempts  to  take  a  full  breath  to 
relieve  this,  or  changes  his    position,  a  severe  fit  of  coughing  is 


ASTHENIC   BRONCHITIS.  273 

brought  on,  sometimes  tcrmiiititiiig  in  vomiting  wliich  gives 
temporary  relief.  If  the  case  terminates  fatally,  tiic  tongue  be- 
comes livid,  the  face  dusky,  the  patient  can  not  lie  down,  and  if 
he  sleeps  it  is  but  for  a  few. moments,  and  wakes  threatened  with 
im[)euding  suffocation  ;  delirium  sets  in,  with  cold  and  clammy 
per.s[)i ration,  and  the  system  is  soon  exhausted. 

In  weak  and  poorly  nourished  children,  this  disease  is  of  fre- 
quent occurrence.  At  first  it  is  noticed  that  the  little  patient  has 
a  protracted  chill,  followed  by  febrile  exacerbation.  The  fever 
is  higher  in  the  afternoon,  but  becomes  less  and  less  marked  as 
the  disease  advances.  Respiration  is  quick  and  wheezing,  the 
pulse  frequent  and  full,  though  soft  and  easily  compressed.  The 
cough  is  persistent,  deep,  and  hollow;  the  expectoration,  at  first 
a  viscid  mucus,  becomes,  as  the  disease  advances,  yellowish, 
greenish,  and  opaque.  Dyspnoea  is  marked  when  the  disease  is 
fully  developed,  and  coining  on  in  paroxysms  it  is  followed  by  a 
long  harassing  cough,  which  frequently  terminates  in  vomiting, 
giving  relief  for  the  time  being.  The  disease  sometimes  con- 
tinues for  days,  or  even  weeks,  terminating  favorably  ;  or  the 
dysj)noea  becoming  more  intense,  wo  observe  symptoms  of 
asphyxia  rapidly  increasing,  and  the  child  dies  of  apnoea. 

DiAcxosiS.. —  ^\'c  form  our  diagnosis  in  this  affection,  by  the 
low  grade  of  febrile  reaction,  marketl  derangement  of  function, 
and  prostration,  that  the  inflammation  is  asthenic  ;  by  the  cough 
and  difficulty  of  respiration,  that  the  respiratory  organs  are  the 
seat  of  the  disease  ;  and  by  the  presence  of  the  mucous  rhoncus 
and  resonance  on  percussion,  that  the  bronchial  tubes  are  the 
parts  involved. 

Prognosis. — When  the  disease  is  mild,  i\  favorable  prognosis 
raay  be  given,  but  when  severe,  it  is  an  oxcxiedingly  dangerous 
affection,  and  our  prognosis  must  be  guarded. 

Treatment. — In  young  childix^n  1  Invariably  pursue  the  one 
course,  and  thus  far  with  suocoss.  Taking  a  soft  cotton  cloth, 
sufficiently  large  to  cover  the  anterior  and  lateral  walls  of  the 
chest,  it  is  spread  evenly  with  lard,  and  dusted  with  the  com- 
pound powder  of  Lobelia  and  Capsicum  (emetic  ])owder  of  the 
Dispensatory)  ;  this  is  ap]>lied  to  the  chest  and  changed  two  or 
three  times  in  the  twenty-four  hours.  Internally  I  prescribe: 
18 


274  DISEASES  OF   CHILDREX. 

^  Tincture  of  Lobelia  3jv  Compound  Tincture  of  Lavender  5ij-, 
Simple  Syrup  Sjss.,  M. ;  half  a  teaspoonful  every  thirty  minutes 
until  the  breathing  becomes  easier,  then  every  hour. 

In  all  of  these  cases  it  is  necessary  that  the  child  be  kept  quiet 
and  warm ;  and  I  always  prefer  that  it  be  kept  in  the  cradle  or 
crib,  rather  than  in  the  mother's  or  nurse's  arms.  Keep  the  ex- 
tremities warm — close  attention  to  this,  will  in  many  cases  be 
the  difference  between  a  successful  or  fatal  termination.  Hot 
flannel  to  the  lower  part  of  the  body,  with  dry  heat  in  the  form 
of  bottles  of  hot  water,  will  fulfill  this  indication. 

In  older  children  when  the  pulse  is  frequent,  I  give  small 
doses  of  Aconite  to  give  strength  to  the  circulation.  It  will  be 
observed  that  as  the  pulse  becomes  less  frequent  under  its  influ- 
ence, it  attains  strength  and  volume.  In  some  cases  the  dull- 
ness and  hebetude,  tending  to  coma,  will  be  an  unfavorable 
symptom.  Here  I  would  add  Belladonna,  using  it  in  doses 
heretofore  named. 

Other  remedies  may  be  indicated,  for  the  disease  presents 
many  phases.  I  have-seen  cases  where  the  hot  sponge  bath, 
stimulating  the  skin,  or  even  where*  the  addition  of  a  small 
portion  of  hydrochlorate  of  ammonia  to  the  liot  water  was  an 
important  means.  Others  are  markedly  benefited  by  the 
quinine  inunction.  We  always  have  the  therapeutic  maxim 
clearly  before  us,  "  that  without  reference  to  the  •  name  of  the 
disease,  whichever  remedy  is  indicated  is  to  be  employed." 

ACUTE    BRONCHITIS. 

Acute  bronchitis  is  of  frequent  occurrence  in  childhood,  and 
forms  the  larger  part  of  those  cases  which  are  known  as  lung 
fever,  and  winter  fever.  In  general  it  does  not  present  those 
acute  features  that  are  noticed  in  the  sthenic  bronchitis  of  the 
adult,  but  many  cases  will  be  quite  severe. 

Causes. — Inflammation  of  the  bronchial  tubes  arises  from 
the  same  causes  that  produce  inflammation  in  other  tissues. 
Exposure  to  cold,  especially  to  the  north  or  east  wind,  sudden 
changes  of  temperature,  etc.,  are  the  common  exciting  causes. 
The  predisposing  causes  are  all  such  as  impair  the  general 
health;  and  as  a  rule,  it  may  be  stated  that  such  causes  will  not 


A.CUTE   BEONCHITIS.  275 

produce  inflammation  unless  the  vitality  or  resisting  power  of 
the  system  is  lowered  from  other  causes. 

Pathology. — The  inflammation  is  confined  to  the  bronchial 
mucous  membrane,  and  in  some  cases  involves  but  a  portion  of 
it,  but  in  severe  cases  it  extends  to  all  the  bronchial  tubes.  At 
first  there  is  determination  of  blood,  and  the  tissue  is  injected, 
swollen,  and  dry,  but  afterward  there  is  impairment  of  the  cir- 
culation and  increased  secretion.  When  children  die  of  the 
disease,  post-mortem  examination  shows  the  mucous  membrane 
thickened  and  softened,  and  the  bronchial  tubes  more  or  less 
clogged  with  accumulated  mucus  and  muco-pus. 

Symptoms. — For  a  day  or  two  the  child  has  symptoms  of 
cold,  with  some  cough.  This  is  succeeded  by  a  chill,  sometimes 
scarcely  noticed  by  the  mother,  but  lasting  from  one  to  four 
hours.  Following  this,  febrile  reaction  comes  up  briskly ;  the 
surface  becomes  hot  and  dry,  the  pulse  is  hard  and  frequent,  and 
the  child  irritable  and  restless ;  the  urine  is  scanty  and  the 
bowels  constipated,  the  tongue  having  a  pretty  uniform  white 
coat.  The  fever  gradually  increases  to  the  third  or  fourth  day, 
remains  stationary  for  from  one  to  four  days,  and  then  declines 
as  the  inflammation  passes  ofl". 

^yith  the  first  coming  on  of  febrile  reaction  the  attention  will 
be  attracted  by  the  irritative  cough,  that  repeats  itself  every  few 
minutes.  It  is  not  yet  the  full  bronchial  cough,  that  is  so  marked 
a  feature  after  the  third  day,  but  is  half  way  between  this  and 
the  hacking  cough  of  pneumonia. 

The  cough  is  dry  and  the  respiration  dry  and  whistling,  and 
when  the  ear  is  applied  over  the  chest,  there  is  a  marked  sibi- 
lance  or  dry  blowing  sound. 

By  the  end  of  the  second  day  we  notice  that  there  is  slight 
secretion  of  a  transparent,  tenacious  white  mucus,  streaked  with 
blood.  This  is  increased  the  third  day,  and  by  the  fourth  it 
commences  to  assume  a  yellowish,  opaque  appearance.  Up  to 
this  time  the  secretion  of  mucus  seems  rather  to  increase  the 
cough,  as  it  is  a  source  of  irritation  and  is  raised  with  difficulty. 

AVhen  secretion  is  fully  established  we  have  a  moist,  blowing 
sound,  or  mucous  rhoncus,  which  is  very  marked.  After  the 
sixth  day,  the  mucus  becoming  yellow  and  opaque,  it  is  raised 
with  less  effort,  and  the  cough  is  not  so  hard  or  so  frequent,  and 


276  DISEASES  OF    CHILDEEN. 

respiration  is  miicli  easier.  From  this  time  there  is  a  gradual 
decline  in  all  the  symptoms,  and  the  patient  is  convalescent  from 
the  seventh  to  the  fourteenth  day  of  the  disease. 

Prognosis. — Though  a  severe  disease,  we  do  not  look  upon  it 
as  a  f  ital  one,  though  occasionally  from  its  intensity  it  becomes 
difficult  to  manage.  If  secretion  commences,  becomes  opaque, 
easily  expectorated,  with  an  abatement  of  the  fever,  the  case  is 
progressing  well  ;  but  if  symptoms  of  imperfect  depuration  of 
the  blood  are  developed,  with  delirium,  the  case  is  a  grave  one. 
During  the  disease,  if  the  sputa  changes  from  an  opaque  to  a 
glairy  white  mucus,  we  may  be  satisfied  that  the  inflammation  is 
redeveloped  in  its  original  intensity. 

Treatment. — The  treatment  will  be  directed  to  lessening  the 
frequency  of  the  pulse  and  temperature,  relieving  the  irritation 
and  stopping  determination  of  blood  to  the  bronchise  and  lungs, 
relieving  irritation  or  other  wrongs  of  the  nerve  centers,  and 
establishing  secretion.  It  is  well  to  have  the  subject  thus  clearly 
in  mind  that  we  may  be  able  to  make  our  diagnosis  and  select 
our  remedies. 

Quite  as  essential  is  it  that  we  know  what  not  to  do,  and  what 
to  keep  friends  from  doing.  We  do  not  propose  that  the  stomach 
or  bowels  of  our  patient  shall  be  irritated  by  cathartics  or  nau- 
seants,  and  we  object  to  the  teas  and  potions  that  friends  are 
inclined  to  give  or  insist  upon  our  giving. 

To  control  the  ])ulse  we  administer  Aconite,  if  the  pulse  is 
small  and  frequent  (Aconite  is  the  child's  sedative),  Veratrum  if 
it  has  volume  and  is  frequent.  They  are  both  good  remedies, 
and  relieve  irritation  of  the  lungs  and  bronchife  as  well  as  the 
general  irritation  which  gives  the  frequency  of  pulse. 

If  the  patient  suffers  ])ain,  (this  may  be  known  by  the  expres- 
sion of  the  face  and  the  cry,)  Bryonia  should  be  added  to  the 
sedative.  If  the  ]>atient  has  a  ]>er.sistcnt  cougii  with  whistling 
in  the  smaller  bronchia',  and  furfluM"  on,  if  there  are  blowing 
sounds  with  free  secretion,  Ij^eeac  should  be  employed.  If  there 
is  an  oppressed  respiration,  with  abundant  mucous  secretion  after 
some  days,  Tjobolia  is  the  r(>modv.  A  very  hot  skin,  but  seem- 
ing almost  on  the  ]>oInt  of  bn^ikliifr  out  into  a  jierspiratiou,  and 
a  full,  o])j>ressod  ]Milse,  calls  for  Knpatorinin  ]ierr. 

The  remedies  that   relieve  wronjrs  of  the  nerve  centers  are 


ACUTE  BRONCHITIS.  277 

suggested  by  symptoms  that  force  themselves  upon  our  notice. 
Tlie  extreme  restlessness,  sensitiveness  to  impressions,  evidences 
of  pain,  sleeplessness,  with  flushed  face,  bright  eyes,  contracted 
pupils,  and  increased  heat  of  the  head,  call  for  Gelseminum. 
The  same  restlessness  and  irritation,  but  with  contraction  of  the 
frontal  muscles,  sharp  pulse,  dud  reddened  papilla;  at  tip  of  the 
tongue,  call  for  Rhus.  The  dullness  and  inclination  to  sleep, 
want  Belladonna. 

In  addition  to  the  remedies  which  influence  the  pulse,  and  re- 
lieve irritation  of  the  nerve  centers,  which  also  lessen  the  tem- 
perature, we  employ  baths  to  lessen  the  heat  of  the  body  and 
improve  the  functional  activity  of  the  skin.  The  bath  may  be 
soap  and  water,  the  alkaline  batii  (bicarbonate  of  potash  is  the 
best),  the  acid  bath,  or  fatty  inunction.  The  temperature  of  the 
bath  is  to  be  determined  by  the  condition  of  the  patient,  as  here- 
tofore named. 

If  the  temperature  is  high,  and  inflammation  active,  a  cold 
pack  may  occasionally  be  used  with  great  advantage — even  an 
entire  wet-sheet  pack  is  a  good  thing.  In  the  majority  of  cases, 
however,  a  hot  pack  is  best,  and  may  consist  of  three  or  four 
thicknesses  of  flannel  wrung  out  of  hot  water,  and  applied  to 
the  chest  over  a  single  thickness  of  flannel  which  is  allowed  to 
remain.  Sometimes  sponging  the  chest  with  hot  water  for  a  few 
minutes,  and  then  covering  it  with  flannel,  exerts  a  good  influ- 
ence. My  favorite  local  application,  however,  and  one  that  is 
always  safe,  is  the  soft  cloth  spread  with  lard,  and  sprinkled  with 
the  Compound  Powder  of  Capsicum.  This  may'  be  renewed 
twice  a  day,  scraping  the  old  off  with  a  knife  and  respreading. 

If  the  irritation  of  the  bronchite  is  so  great  as  to  cause  much 
difficulty  of  respiration,  or  if  tiie  cough  should  be  so  harassing 
as  to  prevent  sleep  and  aggravate  the  fever,  we  may  relieve  the 
patient  by  the  use  of  inlialutions.  The  steam  atomizer  is  an  ad- 
mirable apparatus  in  this  case,  but  if  not  at  hand  we  will  impro- 
vise an  inhaling  apparatus  out  of  a  half  gallon  cup  and  a  hot 
iron.  The  vapor  of  water  alone  is  sufficient  in  most  cases ;  or 
in  some  we  may  use  an  infusion  of  hops,  of  tansy,  of  poj)py 
heads,  or  a  small  portion  of  tincture  of  opium  may  be  added. 
The  inhalation  may  be  repeated  as  often  as  every  one,  two  or 
tliree  hours,  until  the  patient  has  relief. 

The  plan  laid  down  I  think  much  better  than  the  old  method 
by  the   use  of  nauseant  expectorants,  and  while  a  case  might 


278  DISEASES  OF   CHILDREN. 

occasionally  arise  in  the  adult,  where  I  would  use  the  old  method, 
I  do  not  think  I  would  employ  it  in  the  child. 

CHRONIC   BRONCHITIS. 

We  occasionally  meet  with  a  case  that  may  be  classified  as 
chronic  bronchitis,  though  it  does  not  present  all  the  symptoms 
of  that  disease  in  the  adult.  Like  the  disease  in  the  adult,  it  is 
associated  with  an  impairment  of  the  general  health,  and  may 
terminate  in  infantile  phthisis. 

Causes. — The  cause  of  this  bronchial  disease  in  the  child  is 
the  frequent  repetition  of  bronchial  catarrh  from  cold.  At  first 
the  patient  recovers  from  the  attack  well,  but  as  it  continues  to 
be  repeated  the  recovery  is  tardy,  and  less  and  less  perfect,  until 
finally  we  have  the  condition  of  the  respiratory  organs  under  con- 
sideration.    In  other  cases  the  disease  is  the  sequel  of  measles. 

Pathology. — The  disease  is  not  strictly  a  chronic  inflamma- 
tion, but  rather  a  condition  of  the  mucous  membrane  resembling 
that  produced  by  such  inflammation.  The  nutrition  of  the  mu- 
cous tissue  is  impaired,  the  circulation  is  sluggish,  the  tissue 
thickened,  and  there  is  an  increased  mucous  secretion  which 
clogs  up  the  bronchial  tubes.  In  the  severer  cases,  the  secretion 
is  muco-pus,  and  may  be  in  considerable  quantity  and  quite 
offensive. 

SYMPTOMS.-^The  child  has  lost  flesh  and  strength,  and  has  a 
pale  or  sallow  appearance.  The  pulse  is  feeble,  the  extremities 
become  cold  easily,  the  appetite  and  digestion  are  impaired,  the 
bowels  irregular,  and  the  child  is  fretful  and  peevish,  as  we 
should  expect  under  the  circumstances. 

Our  attention  is  called  to  a  bad  cough,  from  which  the  child 
has  suffered  some  weeks,  and  which  has  been  very  intractable. 
We  notice  that  it  is  loose  and  somewhat  hollow,  and  that  more 
or  less  mucous  is  brought  up  by  the  act  of  coughing,  but  gen- 
erally swallowed.  Applying  the  ear  to  the  chest,  we  hear  a  very 
marked  moist  blowing  sound — indeed,  when  secretion  is  free,  it 
had  better  be  called  a  gurgling  or  rattling — as  the  air  passes  into 
and  out  of  the  lungs. 

As  the  disease  progresses,  the  child  becomes  feebler,  its  appetite 
and  digestion  more  impaired,  and  the  cough  worse.     It  has  chills. 


CHEONIC   BRONCHITIS.  279 

followed  by  hectic  fever,  during  which  it  is  irritable  and  restless, 
and  finally  the  strength  is  so  exhausted  that  it  dies  of  inanition. 

Treatment. — The  treatment  of  this  case  requires  considerable 
care,  and  all  harsh  and  unpleasant  remedies  should  be  avoided. 
There  are  two  principal  objects  in  view — to  modify  the  irritation 
and  lessen  the  cough;  and  to  improve  the  appetite  and  digestion, 
and  thus  get  better  nutrition  and  restore  the  structure  of  the  part 
affected. 

If  both  can  be  accomplished  by  one  class  of  remedies  it  will 
be  best,  as  the  child's  stomach  is  easily  irritated,  and  will  not 
tolerate  too  much  medicine.  Frequently  we  will  attain  the  ob- 
ject by  the  use  of  Collinsonia  alternated  with  tincture  of  muriate 
of  iron  and  glycerine;  it  may  be  prescribed  in  the  following 
form:  1^  Tincture  of  Collinsonia  oij-,  Simple  Syrup  S'j- ;  a  half 
teaspoouful  three  times  a  day.  The  preparation  of  iron  may  some- 
times be  changed  for  the  compound  syrup  of  the  hypophosphites. 

Occasionally  we  may  require  something  more  for  the  relief  of 
the  cough,  in  the  earlier  part  of  the  treatment.  Here  I  like  the 
action  of  an  infusion  of  clover  hay,  sweetened  and  given  as 
required.  Or  in  place  of  this  the  Stillingia  Liniment  maybe 
given  in  doses  of  half  to  one  drop  on  sugar,  every  three  or  four 
hours.  When  the  disease  has  arisen  from  measles,  the  Drosera 
will  be  found  a  valuable  remedy,  in  the  proportion  of  gtt.  x.  to 
gtt.  XV.  of  the  tincture  to  water  oiv.;  a  teaspoonful  four  times 
a  day. 

In  some  cases  Veratrum  and  Bryonia  seem  to  exert  an  excel- 
lent influence  in  quieting  bronchial  irritation,  checking  the  cough, 
and  improving  the  general  health.  In  other  cases  we  employ 
Arsenic,  as — I^  Tinct.  Veratrum,  Fowler's  Solution  of  Arsenic, 
aa.  gtt.  v.,  water  .5iv.;  a  teaspoouful  every  two  or  three  hours. 
Humex  is  sometimes  an  excellent  remedy  for  cough,  gtt.  v.  to 
gtt.  X.  being  added  to  water  Si  v.  and  given  in  teaspoonful  doses. 
If  there  is  a  very  free  secretion  of  mucus,  with  much  rattling  in 
the  chest.  Lobelia  with  Compound  Tincture  of  Lavender  may  be 
employed,  as  heretofore  named.  For  further  information,  the 
reader  is  referred  to  my  Practice  of  3Iedicme,  article  "Cough." 

Inunction  with  quinine  is  an  excellent  measure  in  those  cases 
in  which  there  is  feeble  innervation  or  impaired  circulation. 
Generally  fatty  inunction  serves  a  better  purpose  than  the  ordi- 
nary use  of  baths ;  the  surface  being  rubbed  freely  with  the  hand 
or  with  flannel.  "* 


280  DISEASES  OF  CHILDREN. 

Exercise  in  the  open  air,  the  free  admission  of  light  and  sun- 
shine to  the  room,  and  a  nutritious  diet,  are  important  aids  to 
the  cure. 

PNEUMONIA. 

Inflammation  of  the  lungs  is  met  with  most  frequently  during 
the  winter  months,  and  like  acute  bronchitis  it  forms  a  portion 
of  those  cases  known  as  lung  or  winter  fever.  In  some  localities 
it  is  a  very  common  disease,  but  in  others  it  is  seldom  met  with. 
From  what  I  have  noticed  I  should  judge  it  to  be  most  common 
in  localities  exposed  to  north  and  east  winds,  or  indeed  to  any 
winds,  and  rare  in  sheltered  places,  as  by  woods,  hills,  etc.  Thus 
in  Cincinnati,  away  from  the  river,  it  is  rarely  met  with,  but  on 
high  grounds  we  occasionally  see  cases.  On  the  prairies  of  Illi- 
nois, and  in  Northern  Indiana,  Ohio,  and  New  York,  it  is  of  fre- 
quent occurrence. 

Causes. — The  common  cause  of  inflammation  of  the  lungs  in 
children  is  cold,  either  from  direct  exposure,  or  from  sudden 
alternations  af  temperature. 

Pathology. — In  this  case  the  inflammation  is  of  the  paren- 
chyma of  the  lung.  In  some  it  will  progress  as  in  the  adult, 
embracing  all  of  that  part  of  the  lung  which  is  the  seat  of  inflam- 
mation. But  in  the  majority  of  cases  it  is  confined  to  the  lobules, 
and  is  thus  scattered  through  a  large  portion  of  one  or  both  lungs, 
sound  lobules  being  interspersed  between  the  inflamed  ones. 
From  this  character  of  the  disease  it  has  received  the  name  of 
lobular  'pneumonia. 

For  the  first  two  or  three  days  the  lung  presents  the  apponr- 
ance  of  determination  of  blood,  the  capillaries  being  full,  and  the 
tissue  consequently  reddened ;  the  lung  still  floats  on  water, 
though  not  so  freely  as  the  healthy  tissue.  From  this  time  there 
is  a  continued  increase  in  its  density,  the  air-cells  being  effliced 
by  the  engorgement  of  the  capillary  vessels,  and  by  exudation 
into  the  intercapillary  spaces,  and  into  the  air-cells.  This  is  the 
stage  of  red  hejjat!z(i(ion,fxui\  Is  fully  coiupletod  by  the  sixth  day. 
Now,  In  the  majority  of  cases,  resolution  commences,  and  the 
circulation  is  gradually  restored  from  the  circuinfcrcncc  to  the 
center,  tlie  cffiised  material  being  taken  up  as  soon  as  the  blood 
begins  to  flow  freely.     Thus  tlic  lung  is  free  of  both  the  arrested 


PNEUMONIA.  281 

circulation  and  tlie  effusion,  and  becomes  again  permeable  to  air. 
Resolution  is  usually  complete  by  the  ninth  day. 

But  should  the  inflammation  run  so  high  as  to  impair  the 
vitality  of  the  tissues,  then  the  condition  of  gray  hepatization 
may  ensue.  In  this  the  effused  material  is  formed  into  pus,  and 
in  a  still  further  advanced  stage,  the  tissues  losing  their  vitality, 
soften  and  are  likewise  transformed.  If  we  examine  a  lung  in 
this  condition^  we  will  find  it  soft  and  friable,  and  readily 
lacerated  by  the  fingers. 

The  cut  surface  presents  a  yellow  mottled  appearance,  and 
when  pressure  is  made  upon  it  an  imperfect  purulent  fluid 
exudes.  In  a  still  further  advanced  stage  small  abscesses  are 
formed  in  the  lungs  at  the  site  of  the  diseased  lobules. 

SYMPTOiI8. — Usually  the  child  shows  symptoms  of  cold  for 
two  or  three  days  before  the  attack,  and  is  restless  and  fretful. 
In  many  cases  the  commencement  of  the  inflammation  is  an- 
nounced by  a  persistent  hacking  cough,  which  seems  to  arise 
from  irritation  of  the  throat  or  larynx.  What  is  peculiar  about 
this  cough  is,  that  it  seems  to  be  made  by  the  child,  and  fre- 
quently it  will  be  scolded  for  persisting  to  cough  when  it  seems 
to  be  unnecessary.  Such  a  cough  is  always  annoying  to  the  j>er- 
sons  in  the  room  for  its  persistency.  Of  course  there  are  many 
cases  in  which  an  ordinary  cough  follows  the  invasion  of  the  in- 
flammation, and  does  not  precede  it  as  described. 

In  all  cases  there  is  a  chill,  but  in  most  it  is  so  mild  that  it  is 
scarcely  noticed  by  the  parents.  In  the  majority,  febrile  reaction 
comes  up  slowly,  and  for  the  first  twenty-four  hours  the  child 
does  not  seem  to  have  more  fever  than  would  attend  an  ordinary 
bad  cold,  but  even  in  those  cases  it  will  be  noticed  that  the 
cheeks  are  flushed,  that  there  is  too  great  dryness  of  skin,  and 
sharpness  and  hardness  of  the  pulse,  for  a  slight  disease.  In 
other  cases  the  fever  comes  up  rapidly,  and  runs  very  high. 

By  the  third  day  of  the  disease,  a  casual  observer  would  notice 
that  the  child  was  quite  sick.  The  skin  is  hot  and  dry,  the  pulse 
frequent  and  hard,  nrine  scanty,  bowels  constipated,  no  appetite, 
a  coated  tongue,  one  or  both  cheeks  flushed,  and  some  difficulty 
in  respiration.  The  cough  is  usually  paroxysmal,  and  varies 
from  the  hacking  cough  first  named  to  a  deep  bronchial  cough. 
In  some  cases  the  child  is  irritable  and  restless,  but  in  most  lies 
quite  still,  even  though  it  suffers,  and  sleeps  with  its  eyes  partly 
open. 


282  DISEASES   OF   CHILDEEN. 

With  these  symptoms  but  little  changed,  the  disease  continues 
to  the  sixth  day,  when,  in  a  majority  of  cases,  we  find  an  amend- 
ment. The  skin  is  less  dry  and  hot,  the  pulse  softens  and  is 
less  frequent,  secretion  is  gradually  established,  the  difficulty  of 
respiration  and  cough  passes  away,  and  by  the  ninth  day  the 
child  is  free  from  fever  and  convalescent. 

When  it  passes  into  the  stage  of  gray  hepatization,  the  pro.^- 
tration  becomes  alarming.  The  mind  wanders,  and  in  a  short 
time  coma  comes  on,  and,  gradually  deepening,  is  attended  with 
evidences  of  imperfect  aeration  of  the  blood,  from  which  tlie 
child  dies. 

Occasionally  a  very  severe  case  is  met  with,  in  which  evi- 
dences of  asphyxia  are  manifested  as  red  hepatization  advances, 
and  in  which  the  disease  will  terminate  fatally  before  the  sixth 
day,  on  account  of  the  extreme  engorgement.  And  in  very 
feeble  children  there  is  occasionally  a  case  in  which  the  deter- 
mination of  blood  is  followed  by  congestion,  and  such  engorge- 
ment of  the  lungs  is  produced  in  a  few  hqiirs,  that  death  results. 
This  resembles  the  pulmonary  apoplexy  of  the  adult. 

Diagnosis. — The  symptoms  above  named,  cough  and  difficult 
respiration,  point  to  the  lungs  as  the  seat  of  disease,  while  the 
febrile  reaction  evidences  its  inflammatory  character.  Ausculta- 
tion during  the  first  three  days  detects  a  marked  change  in  the 
respiratory  murmur,  which  is  roughened  and  louder,  and  asso- 
ciated with  a  marked  blowing  sound,  at  first  dry,  afterward  moist. 
From  the  third  to  the  sixth  day  the  respiratory  murmur  becomes 
less  and  less  marked,  until  at  last  it  is  scarcely  heard  over  the 
seat  of  inflammation,  but  is  replaced  by  a  moist  blowing  sound 
(mucous  rhoncus).  With  this  change  there  is  increasing  dullness 
on  percussion,  though  it  is  rarely  so  marked  as  in  the  adult. 

We  have  less  evidence  of  diseased  action  from  the  sputa  than 
in  the  adult,  for  children  can  rarely  be  induced  to  spit  out  the 
secretion  removed  by  coughing.  At  first  there  is  dryness  of  the 
mucous  membrane;  in  two  or  three  days  the  secretion  is  white, 
tenacious,  and  has  the  globular  form  so  characteristic  of  the  dis- 
ease in  the  adult ;  about  the  fifth  day  it  acquires  a  reddish-brown 
tinge,  but  rarely  has  the  rusty  hue  that  is  seen  in  the  adult. 
After  this  time,  if  convalescence  progresses,  it  becomes  yellowish, 
and  resembles  the  sputa  of  bronchitis. 


*      PNEUMONIA.  283 

Prognosis. — The  prognosis  in  the  pneumonia  of  children  is 
favorable,  the  mortality  being  but  little  increased  over  remittent 
fever.  This,  of  course,  is  supposing  that  the  patient  has  proper 
treatment  and  good  nursing.  Those  cases  that  manifest  symp- 
toms of  asphyxia  early,  are  to  be  regarded  as  unfavorable,  as  arc 
those  in  which  the  disease  progresses  unabated  beyond  the  seventh 
to  the  ninth  day. 

Treatment. — The  treatment  of  pneumonia  in  the  child  should 
be  quite  simple,  as  it  is  not  a  case  that  will  be  benefited  by  or 
bear  much  medication.  The  indications  are  plain — to  lessen  the 
frequency  and  obtain  a  uniform  circulation  of  the  blood,  to  allay 
irritation  of  the  lungs,  and  to  establish  secretion,  and  this  is  done 
in  the  order  in  which  they  are  named. 

To  accomplish  the  first  object  we  prescribe  the  special  seda- 
tives, Veratrum  and  Aconite,  in  the  usual  doses,  repeated  every 
hour.  If  the  fever  runs  high,  and  the  pulse  is  full  and  hard,  the 
dose  of  the  Veratrum  may  be  doubled  until  it  influences  the 
pulse.  All  we  expect  of  the  remedy  is  that  it  will  hold  the 
febrile  action  and  the  inflammation  in  check,  and  after  twenty- 
four  or  forty-eight  hours  will  cause  a  gradual  decline  in  both. 
That  action  of  Veratrum  which  brings  the  pulse  down  in  six  or 
eight  hours  from  one  hundi'ed  and  thirty  beats  per  minute  to 
eighty  or  seventy  beats  per  minute,  is  not  desirable,  because  it 
can  not  be  maintained,  and  because  it  is  opposed  to  nature's 
methods  of  cure. 

Again,  we  note  the  indications  for  other  remedies  which  may 
be  added  to  the  sedative  solution  or  alternated  with  it.  Bryonia 
is  given  if  the  child  shows  evidences  of  pain  in  respiration  or  on 
coughing ;  Rhus,  If  there  is  contraction  of  the  facial  muscles, 
and  a  sharp  stroke  to  pulse,  which  is  small  and  frequent;  Lobe- 
lia, if  there  is  marked  oppression  in  the  chest,  and  difficult 
breathing ;  Gelsemlnum,  If  there  are  evidences  of  determination 
of  blood  to  the  brain ;  Belladonna,  If  the  child  Is  dull  and  in- 
clined to  sleep  a  great  deal ;  Eupatorium,  If  tlie  pulse  Is  full  and 
oppressed,  and  perspiration  is  caused  by  coughing,  notwithstand- 
ing the  heat  of  skin  ;  Phytolacca,  If  patient  complains  of  sore 
mouth  and  throat ;  Baptlsia,  If  the  face  is  full  and  purplish,  the 
tongue  and  lips  showing  the  same  color. 

When  the  tongue  Is  dirty — a  yellowish,  glutinous  coat — sul- 
phurous acid  exerts  an  excellent  Influence,  and  will  sometimes  be 


284  DISEASKS  OF  CIIILDltEN. 

nearly  all  that  the  patient  will  require.  Occasionally  the  sul- 
phite of  soda  is  indicated,  and  more  rarely  the  chlorate  of  pot- 
ash. A  trituration  of  podophyllin  (second  decimal  or  first  cen- 
tcssimal),  in  doses  short  of  an  action  upon  the  bowels,  will  give 
good  results  in  those  cases  showing  fullness  of  face  and  tissues 
generally,  and  especially  fullness  of  veins,  which  should  bd  noted. 

Cathartics  as  a  rule  are  contra-indicated,  and  if  the  bowels  are 
locked  up,  it  is  much  better  to  use  an  enema  to  open  them.  Two, 
three  or  four  days  without  an  evacuation  of  the  bowels,  is  not 
commonly  injurious,  at  least  it  is  much  better  than  the  irritated 
stomach  and  intestinal  canal  from  physic. 

Ipecacnanha  exerts  a  specific  action  upon  the  respiratory  ap- 
paratus, removing  irritation  and  stopping  determination  of  blood. 
It  has  been  used  alone  with  marked  success,  being  given  tritu- 
rated with  sugar  in  doses  just  short  of  nausea,  or  with  slight 
nausea  for  a  few  hours  and  just  short  of  vomiting.  I  employ 
it  in  tincture  and  combine  it  with  Aconite  gtt.  v.  to  gtt.  x.,  to 
water  Siv. 

As  the  disease  advances,  if  there  be  a  very  free  secretion,  with 
much  rattllivg  in  the  chest,  and  difficulty  of  breathing  from 
obstructed  bronchial  tubes,  the  preparation  of  Lobelia  with 
Comp.  Tinct.  of  Lavender,  as  named  under  the  head  of  asthenic 
laryngitis,  will  answer  a  most  excellent  purpose.  In  this  case 
the  cloth  spread  with  lard  and  sprinkled  with  Compound  Powder 
of  Lobelia  should  not  be  netrlected. 

To  fulfill  the  second  indication  we  apply  a  hot  fomentation  as 
heretofore  named,  or  the  "mush  jacket;"  or  in  young  children, 
where  this  would  be  inconvenient,  the  cotton  cloth  spread  with 
lard  and  s})rinkled  lightly  with  emetic  powder.  The  mush  jacket 
is  made  of  corn  mush  of  ordinary  consistence,  spread  an  inch 
thick  on  cloth  large  enou<rh  to  cover  the  anterior  and  lateral 
portions  of  the  chest,  and  covered  with  mnstpiito-bar,  netting, 
or  other  thin  goods,  to  retain  the  poultice.  It  is  applied  hot, 
a  thinknoss  of  flannel  being  first  laid  over  the  chest,  and  changed 
twice  daily  ;  the  heat  is  retained  by  the  thickness  of  the  poultice, 
and  by  keeping  the  l)()dy  warmly  covered.  The  hot  application 
should  not  be  conliniu'd  lont^rr  than  iho  first  day,  and  then  if 
needed  replaced  by  the  Fiobelia  and  Capsicum. 

In  all  cases  the  air  of  the  i-oom  should  be  kej)t  moist,  and  if 
the  irritation  of  the  lungs  is  great,  with  harassing  cough,  we 
may  obtain   nnwh  advantage   from  the  use  of  inhalations  of  the 


THTHISIS  PULMONALIS.  285 

vapor  of  water,  of  an  infusion  of  hops,  or  tansy,  or  poppy  heads, 
or  of  one  part  of  vinegar  to  three  of  water.  This  not  only  gives 
present  relief,  but  it  aids  the  cure;  indeed,  I  am  not  certain  but 
tluit  the  disease  could  be  very  successfully  treated  by  the  use  of 
inhalations  alone,  adding  the  sedative  to  the  water  employed. 

As  a  general  rule,  we  will  find  the  third  indications  of  cure 
accomplished  by  the  means  already  named.  As  soon  as  the  pulse 
is  brouffht  under  the  influence  of  the  sedatives  there  is  a  natural 
tendency  to  a  re-establish mcnt  of  secretion.  At  the  commence- 
ment of  the  treatment  the  patient  has  a  general  bath  with  soap 
and  water  to  cleanse  the  skin,  and  a  hot  foot-bath  for  its  quiet- 
ing influence  upon  the  nervous  system.  Further  than  this,  I  do 
not  think  bathing  is  beneficial,  except  sponging  the  surface  under 
the  cover,  drying  speedily  and  with  friction. 

The  child  should  be  kept  in  tlie  recumbent  position  in  its 
cradle,  crib,  or  bed,  and  should  be  kept  pleasantly  warm  and  free 
from  all  draughts  and  changes  of  temperature.  If  at  any  time 
during  the  progress  of  the  disease,  there  is  tendency  to  coldness 
of  the  extremities,  apply  dry  heat,  wrapping  the  feet  and  legs  in 
flannel. 

If  the  child  needs  a  stimulant  and  tonic,  T  think  we  may  ob- 
tain the  best  results  from  the  inunction  of  quinine,  as  heretofore 
named. 

AVhen  the  disease  passes  into  the  stage  of  gray  hepatization, 
we  can  do  nothing  more  than  support  the  strength  by  the  use  of 
the  bitter  tonics,  as  they  can  be  given,  and  such  food  as  we  can 
prevail  upon  the  child  to  take.  In  some  cases  advantage  might 
result  from  the  use  of  sulphite  of  soda. 

PHTHISIS   PULMONALIS. 

Infantile  phthisis  is  generally  acute,  resembling  the  hasty  con- 
sumption of  the  adult.  In  this  form  we  meet  with  it  at  all  ages 
from  the  first  weeks  of  life  to  the  age  of  five  or  six  years.  After 
this  time,  phthisis  pulmonalis  is  of  very  rare  occurrence,  until 
the  age  of  puberty  is  past. 

Causes. — The  predisposing  cause  is  a  feeble  vitality,  mani- 
fested especially  in  the  formation  of  blood  and  nutrition  of  tis.-^no. 
In  this  sense  infantile  phthisis  is  always  hereditary,  as  it  is  hardly 
possible  that  a  child  possessing  normal  vital  or  formative  power 


286  DISEASES  OF    CHIL,DREN. 

should  have  this  disease,  even  under  the  most  adverse  circum- 
stances. 

The  exciting  causes  are  all  such  as  still  further  lower  the 
vitality  of  the  child.  Diseases  affecting  the  stomach  and  bowels, 
thus  impairing  digestion,  or  those  which  impair  secretion,  lower 
the  vitality  of  the  blood  and  its  adaptation  as  a  nutritive  fluid. 
If  now  the  child  is  exposed  to  the  ordinary  causes  of  cold,  and 
irritation  of  the  respiratory  organs  is  set  up  with  determination 
of  blood,  the  imperfectly  formed  albumen  will  be  thrown  out  in 
the  parenchyma  of  the  lungs  as  tubercle. 

Pathology. — As  above  stated,  a  congenital  defect  of  via- 
bility lies  at  the  foundation  of  the  disease,  and  as  has  been  pre- 
viously stated,  it  is  impossible  for  some  children  to  live  to  adult 
years  for  this  reason.  This  feeble  viability  is  manifested  in  im- 
pairment of  all  the  functions  of  the  body,  but  especially  in  the 
formation  of  poor  blood.  This  imperfect  elaboration  furnishes 
the  material  for  tubercles,  which  only  requires  an  arrest  of  secre- 
tion by  which  it  is  ordinarily  removed,  and  a  determination  of 
blood  to  the  lungs  for  its  deposit  in  that  tissue. 

Post-mortem  examination  shows  very  extensive  disease.  In 
the  eai'ly  stage  the  lung  is  infiltrated  with  a  yellow  albuminoid 
material  of  cheesy  consistence,  and  showing  but  very  slight,  if 
any,  traces  of  organization.  It  resembles  the  lower  form  of 
yellow  tubercle,  as  seen  in  the  adult.  This  exudation  does  not 
wholly  prevent  the  entrance  of  air  into  the  part  diseased,  for 
even  when  the  deposit  is  extensive,  some  lobules  will  be  found 
free. 

At  a  further  advanced  period  we  will  find  this  material  in 
every  stage  of  breaking  down,  from  that  in  which  it  has  softened 
to  the  ordinary  consistence  of  pus,  to  that  in  which  the  tissue  of 
the  lung  has  yielded,  giving  rise  to  large  and  ragged  abscesses, 
containing  the  debris  of  the  lung  and  the  tubercular  material. 

Symptoms. — The  disease  frequently  commences  as  a  simple 
cold,  manifested  by  coryza,  slight  cough,  seemingly  from  irrita- 
tion of  the  throat,  impaired  appetite,  chilly  sensations  in  the 
morning,  with  febrile  exacerbations  in  the  after  part  of  the  day. 
The  child  is  restless  and  fretful,  and  docs  not  sleep  well  during 
the  day,  at  its  usual  times.  These  symptoms  continue  for  a  week 
or  ten  days,  the  coryza  disappearing,  but  the  cough  increases,  the 
chills  are  more  marked,  and  the  febrile  reaction  higher. 


PHTHISIS   PULMOXALIS.  287 

Prostration  becomes  marked  after  a  few  clays,  and  the  appetite 
is  almost  wholly  lost.  The  patient  is  thirsty,  and  drinks  often, 
especially  at  night,  waking  every  hour  or  two.  Its  sleep  is  also 
disturbed,  and  it  changes  its  position  often,  throwing  off  the 
cover,  and  frequently  expressing  its  uneasiness  in  moaning  and 
short  cries. 

Thus  week  after  week  we  observe  an  increasing  loss  of  flesh 
and  strength,  until  the  child  is  as  much  emaciated  as  in  cholera 
infantum.  And  yet  the  cough  is  not  very  severe,  neither  is 
there  much  difficulty  of  respiration,  or  imperfection  in  the  aera- 
tion of  the  blood.  Still,  these  symptoms  are  sufficient  to  call 
our  attention  to  the  lungs  as  the  seat  of  the  disease.  Quite  fre- 
quently the  blowing  sound  will  be  so  marked  that  it  is  readily 
heard  when  we  sit  down  by  the  side  of  the  child.  Upon  auscul- 
tation it  is  found  to  extend  to  every  part  of  the  lung  tissues. 

Diagnosis. — The  marked  emaciation  and  debility  is  evidence 
that  the  disease,  whatever  it  may  be,  is  one  affecting  the  forma- 
tion of  blood  and  nutrition  of  tissue.  If  in  the  summer,  we 
would  suspect  it  to  be  one  of  the  intestinal  canal,  but  a  careful 
examination  determines  that  this  is  not  the  source  of  the  lesion. 
The  cough,  some  difficulty  in  respiration,  and  the  blowing  or 
rattling  sounds  heard  when  near  the  child,  cause  us  to  make  an 
examination  of  the  chest. 

On  percussion  we  usually  find  a  dullness  over  the  superior 
lobes  of  the  lungs,  sometimes  quite  marked.  But  over  the  mid- 
dle and  lower  lobes  the  resonance  is  clear,  except  in  cases  with 
congestion,  when  there  is  some  dullness  even  here. 

On  auscultation  we  find  a  uniform  blowing  sound  over  the 
entire  chest,  with  more  or  less  mucous  rattling,  as  there  is  more 
or  less  secretion.  Though  it  seems  louder  in  the  sound  lung,  it 
does  not  mask  the  respiratory  murmur  which  is  heard  distinctly. 
In  those  parts  of  the  lung  infiltrated  with  tubercle,  the  blowing 
sound  is  dull,  as  if  deadened  by  passing  through  an  infiltrated 
tissue,  or  the  sounds  are  small,  whistling,  creeping  in  and  out  of 
the  tissues,  sometimes  like  a  nest  of  mice.  Not  uufrequently 
the  dry-crackling  that  so  generally  attends  the  same  disease  of 
the  adult  will  be  heard,  though  but  for  short  periods. 

Prognosis. — The  prognosis  is  unfavorable.  The  disease  oc- 
curs in  children  of  feeble  viability,  and  who  have  little  power  to 
resist  disease  or  of  repair  when  this  is  arrested.     Still,    in    some 


288  DISEASES  OF    CHILDREN. 

cases,  an  infantile  plitliisis  may  be  arrested,  and  by  a  proper  res- 
torative treatment,  aided  by  good  hygiene,  a  moderately  good 
constitntion  may  be  developed  in  time. 

Treatment. — The  treatment  of  this  ease  can  only  be  outlined, 
as  tlie  indications  for  remedies  will  vary,  and  here,  as  elsewhere, 
we  wish  the  right  remedy  for  the  conditions  present,  rather  than 
a  treatment  for  the  name  of  the  disease. 

AVith  a  frequent  pulse  and  increased  temperature,  we  think  of 
Veratrum  as  a  good  basis  of  treatment.  If  there  is  pain  in  the 
chest,  Bryonia  is  given  for  a  few  days,  and  is  then  replaced  with 
Arsenic  if  the  skin  shows  atony ;  continuing  in  this  way  for  a 
time,  these  remedies  may  be  replaced  with  hypophosphite  of  lime 
alone,  or  with  some  preparation  of  malt  given  after  meals. 

We  can  not,  at  first,  use  bitter  tonics  and  restoratives  by  mouth 
with  advantage,  and  we  will  therefore  employ  them  cndermically. 
The  inunction  of  quinine,  heretofore  spoken  of,  will  answer  a 
very  excellent  purpose.  Even  simple  fatty  inunction  will  be 
found  beneficial.  If  the  parents  can  afford  it  as  well  as  not,  let 
the  inunction  be  of  good  cod-liver  oil,  with  quinine  in  the  pro- 
portion of  5jj.  to  the  pint.  Let  the  entire  surface  be  thoroughly 
rubbed  with  this  once  or  twice  daily,  using  considerable  friction. 
No  exposure  of  the  surface  should  be  permitted  at  these  times, 
but  the  child  kept  carefully  covered.  The  fatty  matter  may  be 
removed  from  the  skin  with  a  soft  flannel. 

AVashing  with  water  is  absolutely  prohibited,  except  the  face 
and  hands. 

The  same  directions  for  diet  should  be  given  as  in  a  case  of 
cholera  infantum,  and  if  there  is  irritation  of  the  stomach  and 
bowels,  the  same  remedies  may  be  used  to  relieve  it. 

As  the  child  improves,  we  may  put  it  upon  the  use  of  tincture 
of  muriate  of  iron  and  glycorino,  as  heretofore  named,  and 
sometimes  we  may  add  a  small  portion  of  the  tincture  of  Nux 
Vomica  to  it. 

Probably  a  better  restorative  in  this  case  will  be  found  in 
the  compound  syrup  of  the  hypo])hosphitos,  wliich  is  not  only 
very  pleasant  to  the  taste,  but  is  o:isily  npju-oprinted.  The  dose 
for  a  child  two  years  old  will  be  one-tliird  of  a  teaspoonful  four 
times  a  day. 

Cod-liver  oil  answers  a  very  good  purpose  when  it  can  be 
taken.  But  with  the  majority  of  children  under  six,  we  will 
find  it  impossible  to  give  it. 


DENTITION.  289 


As  the  child  becomes  stronger,  it  should  be  taken  out  of  doors 
when  the  weather  is  warm,  and  the  air  calm ;  and  it  should  also 
be  persuaded  to  use  its  limbs,  and  take  moderaCe  exercise.  When 
it  can  not  be  taken  out  of  doors,  its  chair  or  crib  should  be  so 
placed  that  it  may  receive  abundance  of  light,  and  even  sunshine, 


if  not  too  bright. 


CHAPTER    VII. 

DISEASES  OF  THE  DIGESTIVE  APPARATUS. 


The  digestive  apparatus  embraces  the  mouth,  the  throat,  the 
stomach,  and  small  and  large  intestines.  The  diseases  we  have 
to  study  are  those  of  the  mucous  membrane  of  these  several 
parts,  and  of  their  functions.  We  take  it  for  granted  that  dis- 
eases of  mucous  structure  will  demand  a  somewhat  similar 
treatment,  no  matter  what  its  location.  If  this  view  is  correct, 
we  will  have  simplified  the  therapeutics  of  this  class  of  diseases, 
and  will  also  have  made  it  more  definite. 

DENTITION,  AND  ITS   DERANGEMENTS. 

Dentition  is  usually  regarded  as  the  great  trial  of  the  health, 
if  not  of  the  life,  of  the  child,  and  we  find  parents  and  even 
physicians  speaking  of  it  as  if  it  were  a  morbid  process,  instead 
of  a  physiological  development.  It  is  true  that  during  the 
cutting  of  the  teeth  there  is  occasional  disturbance,  sometimes 
of  one  function,  sometimes  of  another,  but  more  frequently  of 
the  digestive  tract.  But  the  majority  of  these  are  but  indirectly 
influenced  by  dentition,  and  the  cause  should  be  sought  elsewhere. 

The  error  is  an  important  one,  because  it  obscures  real  causes 
of  disease,  and  prevents  the  direction  of  remedial  agents  for 
their  removal.  And  with  some  persons  it  leads  to  interference 
with  the  natural  eruption  of  the  teeth,  which  proves  injurious. 

As  a  general  rule,  the  child   exhibits  evidences  of  buccal  ex- 
citement about  the  fourth  or  fifth  month.     There  is  an  increase 
of  the  salivary  secretion,  and  it  has  a  strong  desire  to  bite  or 
press  its  gums  strongly  against  whatever  is  given  it. 
19 


290  DISEASES   OF  CHILDREN. 

This  excitement  continues  to  the  eruption  of  the  first  teeth — 
the  front  incisors — which  occurs  from  the  sixth  to  the  eighth 
month.  In  some  cases,  the  excitement  becomes  general,  and 
thiere  is  restlessness  and  irritability  of  the  nervous  system,  fever, 
derangement  of  digestion,  and  sometimes  diarrhoea. 

The  treatment  of  such  a  case  is  very  simple.  The  child  has  a 
bath,  and  x)nce  or  twice  a  day  a  hot  foot-bath.  "We  prescribe 
Aconite  in  the  usual  doses,  and  if  there  is  much  derangement  of 
the  stomach  and  bowels,  small  doses  of  an  infusion  of  compound 
powder  of  rhubarb  and  potash,  to  produce  a  gentle  laxative  in- 
fluence upon  the  bowels. 

Usually  when  dentition  is  attended  with  such  derangements, 
the  subsequent  cutting  of  the  teeth  will  be  attended  with  more 
irritation  than  the  first.  Especially  is  this  the  case  in  feeble 
children,  at  the  eruption  of  the  molars  and  canine  teeth,  during 
the  second  summer.  But  these  cases  need  but  the  treatment 
just  named,  unless  there  is  a  distinct  complication,  which  will 
be  treated  as  noticed  hereafter. 

Lancing  the  Gums. — Lancing  the  gums  is  an  old  practice, 
and  is  now  somewhat  out  of  vogue.  When  the  lancet  was  the 
remedy  for  adult  fevers  and  infllammation,  lancing  the  gums  was 
the  remedy  for  all  irritations  supposed  to  arise  from  teething. 
Its  use,  therefore,  while  sometimes  beneficial,  was  frequently 
injurious. 

The  eruption  of  the  teeth  through  the  gums  is  not  a  sudden 
nor  a  forcible  process.  As  the  teeth  attain  increased  size  they 
press  upon  the  gum,  which  is  as  gradually  absorbed  before  them, 
and  in  the  true  physiological  process  there  is  no  disturbance 
whatever.  The  lesions  we  notice  result  from  the  deterioration 
of  the  child,  induced  by  our  abnormal  civilization. 

The  cases  in  which  the  gums  may  be  cut  to  advantage  are 
those  in  which  there  being  the  lesions  of  the  nervous  system  and 
fovor,  that  have  been  already  noticed,  there  is  marked  swelling 
and  lividity  or  duskiness  of  the  gums,  over  the  point  where  the 
tooth  is  to  make  its  appearance.  In  such  cases,  occasionally, 
])ronipt  relief  follows  the  incision  of  the  gum,  and  the  relief  of 
its  tension  by  the  discharge  of  a  small  quantity  of  blood.  It 
seems  evident  that  it  is  the  discharge  of  the  blood  which  relieves 
the  tension  upon  the  parts,  and  in  the  same  degree  the  irritation, 
and  not  the  coming  through  of  the  tooth,  as  many  persons  think. 


DENTITION.  291 

The  tooth  is  cut  none  the  quicker  for  the  lancing  of  the  gum.  It 
has  to  come  through  by  a  process  of  growth,  and  this  is  a  matter 
of  time,  so  that  days,  and  sometimes  weeks,  will  elapse  before  it 
has  fairly  made  its  appearance. 

In  lancing  the  gums  a  sharp  knife,  bistoury,  or  gum  lancet, 
should  be  used,  and  the  incision  should  be  directly  down  upon 
the  crown  of  the  tooth.  The  lancet  should  not  be  cut  against 
the  tooth,  however,  so  as  to  injure  it,  as  it  is  yet  delicate. 

Hemorrhage  after  lancing  a  tooth  sometimes  occurs,  and  I 
have  seen  two  cases  in  which  it  proved  fatal.  Of  course,  these 
were  exceptional  cases,  the  children  being  of  a  hemorrhagic 
diathesis.  Still,  free  and  somewhat  persistent  bleeding  is  not 
uncommon.  Occasionally  the  application  of  common  salt  or 
wood  soot  will  arrest  it,  or  a  portion  of  spider's  web  held  on  the 
incision  for  a  few  minutes  with  the  fingers  will  answer  the  pur- 
pose. The  most  certain  means  of  arresting  hemorrhage  in  any 
such  operation  about  the  mouth,  is  the  application  of  tanner's 
shavings  to  the  part.  It  seems  something  like  the  crude  medi- 
cation of  centuries  ago  to  recommend  tanner's  shavings  or  a 
cobweb,  when  our  materia  medica  is  so  full  o'f  astringents  ;  but  a 
rather  troublesome  experience  has  taught  me  that  suoh  means 
are  not  to  be  rejected,  when  found  beneficial.  In  my  own  person 
I  had  hemorrhage  for  four  days,  from  the  extraction  of  a  molar 
tooth,  until,  from  loss  of  blood,  I  could  not  maintain  the  erect 
position.  All  the  ordinary  means  had  been  tried,  without  any 
permanent  effect,  including  the  persistent  use  of  persulphate  of 
iron.  The  part  was  cleansed  of  clots,  and  while  bleeding  freely, 
the  tanner's  shavings  were  applied,  and  in  fifteen  minutes  it  was 
wholly  arrested. 

Taking  Care  of  the  Teeth. — There  are  but  few  parents 
who  everthink  of  caring  for  the  teeth  of  the  child.  They  know 
they  have  to  serve  but  a  short  time,  and  then  be  replaced  with 
permanent  ones.  These  milk  teeth,  however,  serve  just  as  im- 
portant a  purpose  with  the  child  as  with  the  adult.  Their  loss, 
I  am  satisfied,  tends  to  injure  the  health  of  the  child,  as  it  im- 
pairs mastication,  insalivation  and  digestion.  Manv  a  case  of 
dyspepsia  of  the  child  three  or  four  years  old  may  be  traced  to 
this  cause. 

As  a  means  of  preserving  the  teeth,  I  would  recommend  that 
the  child  be  taught  to  wash  the  month  with  cold  water,  or  water 
to  which  a  small  quantity  of  salt  has  been  added.     The  decay  of 


292  DISEASES   OF   CHILDREN. 

the  teeth  is  owing  in  part  to  the  decomposition  of  food  between 
and  adherent  to  the  teeth,  and  if  the  mouth  is  thus  cleansed  after 
eating,  this  cause,  at  least,  will  be  removed. 

The  first  permanent  molars  make  their  appearance  about  the 
third  or  four  year,  and  are  very  commonly  mistaken  for  tera- 
j)oi'ary  teeth.  These  not  unfrequently  become  carious,  from  the 
cause  above  named,  from  the  sixth  to  the  eighth  year.  When 
this  is  the  case,  advise  that  the  child  be  taken  to  a  dentist,  and 
have  the  teeth  properly  filled. 

Second  Dentition. — The  loss  of  the  deciduous  or  milk  teeth 
commences  between  the  fifth  and  the  sixth  year — or  should  com- 
mence at  that  time.  There  is  a  gradual  absorption  of  the  fangs 
of  the  teeth,  as  the  permanent  ones  are  developed  beneath  them. 
After  a  time  they  become  loosened,  so  that  sometimes  they  can 
readily  be  pulled  out  with  the  fingers.  If  not  removed  in  time, 
the  permanent  teeth  press  them  to  one  side,  or  forward,  or  back- 
ward. This  gives  rise  to  present  deformity,  disease  of  the  gum, 
and  may  so  change  the  position  of  the  permanent  teeth  as  to 
occasion  lasting  deformity.  When  it  is  noticed  that  they  have 
become  loosened,  or  that  the  permanent  teeth  are  coming  through, 
they  should  be  extracted.  This  is  but  a  little  matter,  as  the 
teeth  have  mostly  lost  their  fangs. 

I  do  not  like  the  extraction  of  the  deciduous  teeth  before  this 
time,  not  only  because  the  child  loses  the  use  of  them,  but  be- 
cause the  jaw-bone  is  sometimes  imperfectly  developed,  in  conse- 
quence, and  we  have  irregularity  of  the  permanent  set. 

It  is  of  importance  that  the  permanent  set  of  teeth  be  well- 
formed  and  properly  placed,  so  as  to  form  a  regular  and  uniform 
arch.  It  is  not  only  a  matter  of  good  looks,  but  also  of  good  teeth. 

It  is  my  impression  that  if  the  general  health  of  the  patient  is 
good,  and  it  is  furnished  with  the  material  for  the  formation 
of  bone,  in  such  form .  as  it  can  appropriate  it,  the  teeth  will  be 
regular  and  good. 

If  a  patient  is  presented  to  me  showing  an  irregular  or  deformed 
dentition,  I  prescribe  for  the  general  disease,  as  if  manifested  by 
other  symptoms  of  imperfect  nutrition,  the  usual  proportion  of 
iron  for  children  :  R  Tincture  of  Muriate  of  Iron  .5.).,  Glycerine 
.^iv.,  a  teaspoonful  three  times  a  day.  The  hypophosphite  of 
Hmo,  or  more  frequently  phosphate  of  soda,  in  small  quantities, 
furnishes  the  phosphorus;  while  a  nutritious  diet,  properly  se- 


STOMATITIS.  293 

lected,  (oat-meal  is  very  good,  so  is  cracked  wheat,)  and  such 
hygienic  means  as  seem  to  be  necessary  in  the  case,  complete 
the  treatment. 

When  the  teeth  are  developed  irregularly,  as  regards  the  arch, 
or  overlap  one  another,  or  are  angular,  as  it  were  twisted  upon 
their  axis,  much  may  sometimes  be  done  by  simple  means.  When 
a  tooth  is  outside  or  inside  of  the  line  of  the  arch,  pressure  with 
the  thumbs  or  fingers  toward  the  proper  place  two  or  three  times 
a  day,  will  usually  accomplish  the  object.  Of  course,  in  these  as 
well  as  other  irregularities,  the  deciduous  teeth  should  be  removed. 
Occasionally  we  will  find  a  fang  of  one  of  these  teeth  overgrown 
by  the  gum  so  that  it  is  not  noticed.  A  careful  examination  dis- 
covers it,  and  being  removed,  the  cause  of  the  deformity  being 
gone,  we  find  the  teeth  speedily  assuming  their  proper  position. 

The  physician  may  instruct  the  parents  as  regards  such  man- 
ipulation, who  will  pursue  it  for  some  months,  as  the  change  is  a 
very  slow  one.  AVhen  the  deformity  is  greater  than  we  can  ex- 
pect to  overcome  by  such  means,  we  recommend  that  a  dentist 
be  consulted,  who  may  apply  such  artificial  support  or  pressure 
as  will  accomplish  the  object. 

STOMATITIS. 

Inflammation  of  the  month  in  childhood  assumes  a  number  of 
different  forms,  which  really  differ  in  patliology  and  treatment. 
In  some  of  them  the  sore  mouth  is  the  primary  disease;  in  oth- 
ers it  is  secondary  and  symptomatic  of  some  other  affection.  They 
range  from  a  simple  erythematous  inflammation,  which  disap- 
pears of  itself  in  a  day  or  two,  to  that  profound  lesion  in  which 
the  tissues  soften  and  break  down  as  it  progresses. 

We  may  divide  these  diseases  into  the  following  classes  :  Stom- 
atitis Simplex,  Aphthae,  Stomatitis  Ulcerata,  Gangrenous  Stom- 
atitis. 

STOMATITIS  SIMPLEX. 

Simple  sore  mouth  may  be  caused  by  cold,  or  by  gastric  irrita- 
tion, in  some  cases  being  the  result  of  the  two.  The  child  first 
complains  of  its  food  burning  or  smarting  the  mouth,  or  if  too 
young  to  make  its  sufferings  known,  it  will  be  noticed  that  it 
cries  when  it  nurses.  On  examination  the  mouth  will  be  found 
reddened  and  hot. 


294  DISEASES  OF  CHILDREN. 

Frequently  the  inflammation  is  so  slight  that  it  will  pass  away 
of  itself  in  two  or  three  days;  but  in  other  cases,  especially  those 
which  are  dependent  upon  gastric  disease,  it  will  be  remarkably 
persistent. 

Treatment. — In  a  large  number  of  cases,  Phytolacca  is  a 
very  certain  and  speedy  remedy,  and  I  prefer  its  internal  use  to 
"  mouth  washes."  As  there  is  usually  slight  fever,  the  prescrip- 
tion will  be — I|j  Tinct.  Aconite  gtt.  ij.  to  gtt.  v.,  Phytolacca  gtt. 
V.  to  gtt.  X.,  water  Siv.;  a  teaspoonful  every  hour.  Occasionally 
the  indications  will  point  distinctly  to  Rhus,  when  it  may  replace 
the  Aconite. 

The  local  treatment  is  quite  simple.  An  infusion  of  sage, 
sweetened  with  honey  or  loaf  sugar,  and  borax  added  in  the  pro- 
portion of  one  drachm  to  four  ouncesans^yers  very  well.  An  in- 
fusion of  Hydrastis,  of  Coptis,  or  of  Haraamelis,  will  also  an- 
swer a  good  purpose.  Or,  instead  of  these,  a  solution  of  chlorate 
of  potash,  gr.  x.  to  water  5iv.,  may  be  employed. 

In  those  cases  which  depend  upon  gastric  irritation,  ipecac  may 
be  added  to  internal  remedies,  or  an  infusion  of  compound  pow- 
der of  rhubarb  and  potash  may  be  given  until  it  has  a  slight  lax- 
ative effect.  If  the  case  is  a  persistent  one,  this  may  be  followed 
by  the  subnitrate  of  bismuth,  or  liquor  bismuth.  In  other  cases 
benefit  will  result  from  the  use  of  small  doses  of  tincture  of  mu- 
riate of  iron  with  glycerine. 

APHTHA. 

Aphthse  occurs  in  three  conditions  of  the  system  :  as  a  simple 
sore  mouth  with  exudation  from  gastric  irritation,  in  cachectic 
conditions  of  the  system,  of  which  it  may  be  an  evidence,  and 
as  an  attendant  upon  severe  forms  of  disease,  being  met  with 
especially  in  their  later  stages  wlien  the  vital  power  is  nearly 
exhausted. 

In  the  first  case  the  aphthous  sore  mouth  yields  readily  to 
treatment,  and  is  never  regarded  as  presenting  any  danger.  In 
tlie  other  two  it  is  a  very  grave  symptom,  indicating  a  depression 
of  the  power  to  live,  which  renders  the  prognosis  unfavorable. 

Symptoms. — The  symptoms  of  aphthae  are  well  marked.  The 
child  exhibits  evidences  of  a  sore  mouth,  and  complains  of  ten- 
derness, smarting  or  burning,  when   eating;  or,   if  nursing,   it 


APHTHA.  295 

cries  when  it  takes  the  breast,  and  sometimes  refuses  it  except 
when  pressed  by  hunger.  As  it  occurs  in  very  young  children, 
this  will  be  the  principal  evidence  of  the  seat  of  the  disease. 
The  child  is  fretful,  uneasy,  does  not  sleep  well,  has  considerable 
fever,  and  cries  persistently  when  it  is  given  the  breast,  and  fre- 
quently lets  it  go,  bursting  out  into  a  prolonged  and  painful  cry. 

Our  attention  being  thus  attracted  to  the  mouth  as  the  seat  of 
a  disease,  we  find  the  mucous  membrane  somewhat  swollen,  red- 
dened, especially  in  patches,  upon  which  there  are  numerous 
small  white  points  of  exudation.  The  mouth  is  quite  tender  to 
the  touch,  and  the  child  cries  when  it  is  examined.  As  the  dis- 
ease progresses  these  points  of  exudation  become  more  numerous, 
until  finally  the  greater  part  of  the  buccal  surface  is  thus  cov- 
ered. "When  it  occurs  in  cachectic  children,  or  in  low  forms  of 
disease,  the  exudation  occasionally  extends  to  the  tongue,  covers 
the  roof  of  the  mouth,  and  sometimes  involves  the  throat  and 
nasal  passages. 

The  evidence  of  gastric  disturbance  will  frequently  be  obscured 
by  the  sore  mouth,  but  in  almost  every  case  there  will  be  found 
some  lesion  of  this  kind.  There  is  also  a  real  febrile  action,  and 
not,  as  some  might  think,  simply  a  sympathetic  disturbance  of 
the  circulation. 

Treatment. — In  many  cases  the  small  dose  of  Aconite  with 
Phytolacca  will  be  a  very  much  better  treatment  than  the  old 
plan.  If  there  is  no  fever  the  Phytolacca  may  be  given  alone, 
gtt.  V.  to  gtt.  X.  to  water  .5iv.;  a  teaspoonful  every  one  to  three 
hours.  If  the  face  is  full  and  purplish,  and  the  tongue  and  mu- 
cous membrane  of  the  mouth  have  a  purplish-red  hue,  Baptisia 
should  be  substituted  for  the  Phytolacca.  If  the  tongue  is  red 
and  covered  with  a  glutinous  coating,  sulphurous  acid  may  be 
given  in  small  doses,  and  also  used  as  a  wash  for  the  mouth.  In- 
deed I  think  that  in  many  cases  it  gives  us  the  best  local  appli- 
cation. If  there  are  erythematous  spots  of  eruption  on  the  sur- 
face, or  small  vesicles  appear  about  the  mouth,  or  there  are  start- 
ings  in  sleep,  with  contraction  of  the  facial  muscles,  Rhus  should 
be  alternated  with  Phytolacca.  If  there  has  been  a  retrocession 
of  an  eruption,  or  we  think  there  is  an  eruption  under  the  skin, 
the  patient  will  usually  be  dull  and  inclined  to  sleep,  and  we 
give  Belladonna. 


296  DISEASES   OF   CHILDREN. 

These  means  I  regard  as  of  more  impbrtance  than  the  local 
treatment,  for  with  the  removal  of  the  internal  disease  the  aph- 
thae disappears.  The  use  of  Aconite  and  small  doses  of  sulphite 
of  soda,  are  the  most  valuable  of  these  in  a  majority  of  cases. 

As  a  local  application,  an  infusion  of  Baplisia,  a  solution  of 
chlorate  of  potash,  or  sulphite  of  soda,  or  sulphurous  acid,  may 
be  employed.  It  may  be  applied  with  a  soft  cloth  or  sponge, 
care  being  taken  not  to  rub  or  irritate  the  mouth.  If  the  direc- 
tions are  not  explicitly  given,  we  will  find  the  mother  or  nurse 
trying  to  rub  the  white  spots  off  with  the  wash,  or,  as  she  ex- 
presses it,  she  is  trying  to  clean  the  mouth.  You  do  not  want 
the  mouth  cleaned,  but  the  medicine  applied. 

When  the  aphthae  is  associated  with  a  cachectic  condition,  the 
treatment  should  be  decidedly  tonic  and  restorative,  and  this 
should  be  aided  by  a  nutritious  diet  and  such  hygienic  means  as 
will  improve  the  general  health.  When  it  can  be  taken,  cod- 
liver  oil  answers  a  very  good  purpose.  Alternated  with  this  we 
may  give  small  doses  of  tincture  of  muriate  of  iron  with  glyce- 
rine. The  hypophosphite  of  soda,  twice  a  day,  will  be  a  good 
addition  to  the  treatment  in  some  cases;  or  in  place  of  the  iron 
and  hypophosphite  as  named,  the  compound  syrup  of  the  hypo- 
phosphites  may  be  used. 

The  quinia  inunction  will  prove  beneficial  in  these  cases.  It 
should  be  applied  with  brisk  friction,  so  as  to  stimulate  the  skin 
to  absorption. 

The  food  should  be  principally  animal ;  the  lean  of  beef,  mut- 
ton, game,  milk,  eggs,  etc.,  will  give  a  proper  diet.  Not  un- 
frequently  changing  the  diet  from  farinaceous  slops  to  well 
cooked  meats,  and  a  plentiful  supply  of  milk  and  eggs,  is  better 
than  any  medication. 

No  treatment  can  be  laid  down  for  those  cases  of  aphthae,  which 
appear  in  the  later  stages  of  acute  disease.  It  evidences  the 
need  of  restorative  medication,  and  the  appropriation  of  food, 
but  this  has  been  clearly  seen  before  the  aphthae  made  its  appear- 
ance. All  that  can  be  said  is,  let  every  effort  be  directed  to 
placing  the  stomach  in  condition  for  the  appropriation  of  some 
food  ;  and  by  the  use  of  restoratives  increase  the  power  of  diges- 
tion and  assimilation,  and  by  the  use  of  that  class  called  anti- 
septic, lessen  the  rapidity  of  decomposition. 


STOMATITIS.  297 . 

STOMATITIS    ULCERATA. 

This  is  not  a  very  common  form  of  sore  mouth  with  children, 
but  is  sometimes  quite  severe.  It  is  difficult  to  determine  the 
cause,  and  why  an  ulcerative  inflammation  should  be  set  up  in  a 
person  seemingly  otherwise  healthy.  We  may  surmise  some 
depravation  of  the  blood,  but  we  can  give  no  reason  why  it  should 
manifest  itself  in  disease  of  the  mucous  membrane  of  the  mouth, 
rather  than  other  mucous  membranes,  or  even  other  tissues. 

Symptoms. — We  have  in  this  case  the  same  evidences  that  the 
mouth  is  sore,  that  have  been  named  before.  The  child  manifests 
pain  when  it  nurses  or  when  it  eats.  If  old  enough  to  express 
its  sufferings,  it  complains  of  burning  and  heat  in  the  mouth, 
and  a  feeling  of  stiffness.  Sometimes  its  voice  will  be  changed, 
and  it  can  not  articulate  distinctly. 

On  examination  the  mucous  membrane  will  be  found  present- 
ing a  uniform  red  blush,  but  patches  will  be  markedly  reddened, 
usually  somewhat  discolored,  dusky,  livid,  or  blanched,  and 
somewhat  swollen.  At  a  later  stage  of  the  disease,  these  swell- 
ings will  have  increased,  and  a  vesicle  having  formed  and  rup- 
tured, a  superficial  ulcer  will  present.  These  ulcers  will  vary  in 
size  from  the  head  of  a  pin  to  a  dime,  and  in  depth  from  a  simple 
excoriation  or  removal  of  epithelium,  to  a  deep  excavation  which 
passes  through  the  mucous  membrane.  The  ulcers  are  covered 
with  a  grayish  or  yellowish  exudation,  which  when  removed, 
leaves  a  red  base. 

In  some  exceptional  cases,  the  disease  continues  to  increase  for 
several  days,  and  the  ulcers  are  numerous  and  deep.  There  is 
free  secretion  of  saliva  of  a  sticky  and  tenacious  character,  which, 
with  the  secretion  from  the  ulcers,  and  an  increased  mucous 
secretion,  is  removed  with  some  difficulty,  and  keep  the  mouth 
in  a  very  unpleasant  condition. 

Treatment. — The  constitutional  treatment  in  this  case  is  of 
more  importance  than  the  local  means.  True,  in  some  mild 
cases,  the  use  of  chlorate  of  potash  as  a  wash,  and  internally, 
will  bo  sufficient.  When  the  tongue  is  broad,  pallid  and  seems 
swollen,  I  like  the  action  of  sulphite  of  soda,  in  doses  of  two  to 
five  grains,  every  three  hours.  Where  it  is  red  and  covered  with 
a  glutinous  nasty  coat,  sulphurous  acid  is  the  remedy.     In  other 


298  DISEASES   OF  CHILDREN. 

cases  the  use  of  tlucture  of  muriate  of  iron  with  glycerine  may 
be  alternated  with  it. 

The  remedies  named  under  the  head  of  aphthae  may  find  a 
place  here,  according  to  the  indications,  Phytolacca  being  especi- 
ally a  good  remedy.  Following  this,  quinia  with  hydrastine 
may  be  given,  or  when  there  are  objections  to  the  use  of  quinia 
by  mouth,  it  may  be  employed  by  inunction.  Occasionally, 
small  doses  of  triturated  Podophyllin  can  be  used  with  advantage, 
but  it  must  never  be  carried  beyond  a  slight  laxative  effect. 
The  cases  in  which  I  would  deem  it  necessary,  would  be  those 
where  the  tongue  was  covered  uniformly  with  a  yellowish  coat, 
some  tumidity  of  bowels,  with  papescent  and  clay-colored  stools. 

The  local  applications  in  this  form  of  sore  mouth  are,  an  infu- 
sion of  the  baptisia,  sulphurous  acid,  or  sulphite  of  soda.  As 
already  named,  the  chlorate  of  potash  answers  well  in  the  mild 
cases,  but  can  not  be  depended  upon  in  those  more  severe.  An 
infusion  of  Hamamelis  is  a  good  mouth  wash  in  some  cases. 
And  in  very  stubborn  ones  a  decoction  of  equal  parts  of  E,umex 
crispus,  Alnus  serrulata,  and  Quercus  rubra. 

Occasionally  one  or  two  ulcers  will  be  very  persistent,  and  not 
yield  to  the  ordinary  treatment.  Such  may  be  lightly  touched 
with  the  stick  nitrate  of  silver. 


GANGRENOUS  STOMATITIS— CANCRUM  ORIS. 

Cancrum  oris  may  follow  stomatitis  ulcerata,  but  in  the  ma- 
jority of  cases  is  a  distinct  disease.  There  seems  to  be  a  depra- 
vation of  the  fluids,  and  an  impairment  of  the  vitality  of  the 
solids.  It  bears  a  very  close  relationship  to  cynanche  maligna^ 
and  presents  many  of  the  same  symptoms. 

Symptoms. — Gangrenous  stomatitis  commences  with  a  hard- 
ness and  swelling  of  the  cheek  and  lips;  when  this  appears  exter- 
nally, it  presents  a  blanched  glossy  appearance.  On  examining 
the  mouth  we  find  but  little  tenderness,  the  part  swollen  being 
but  slightly  redder  than  usual,  more  frequently  dusky,  livid,  or 
blanched,  and  having  in  its  center  an  ash-colored  eschar.  The 
tongue  is  pale  and  somewhat  coated,  the  stomach  and  bowels 
deranged,  with  marked  exhaustion  and  cachexia,  with  languor 
and  restlessness. 


STOMATITIS.  299 

The  eschar  soou  spreads,  sometimes  exteuding  to  the  lips  aud 
gums,  and  is  attended  with  a  copious  discharge  of  saliva,  which 
soon  becomes  fetid;  the  secretions  of  the  mouth  and  the  breath 
are  quite  offensive.  As  the  ulcer  progresses  it  extends  both  in 
depth  and  circumference.  Passing  through  the  mucous  mem- 
brane, it  involves  the  cellular  tissue,  and  frequently  dissects  the 
parts  for  some  distance  beyond  the  circle  of  ulceration.  Thus 
the  ulcer  is  larger,  and,  in  every  respect  worse,  deeper  in  between 
the  tissues,  than  it  shows  in  the  mouth. 

Still  progressing,  it  destroys  part  after  part,  until  near  the  sur- 
face. Xow  a  small  vesicle  or  pale  ashy-colored  spot  is  formed 
upon  the  skin,  which  soon  becomes  livid  and  sloughs.  The 
ulceration  now  spreads  rapidly,  destroying  the  muscles,  integu- 
ment, and  bones,  until  death  terminates  the  child's  sufferings. 

When  the  ulceration  has  progressed  in  this  way,  recovery  oc- 
casionally takes  place,  leaving  the  child  fearfully  deformed.  In 
olden  times,  when  mercury  was  constantly  used  for  all  ailments, 
such  cases  of  stomatitis  were  not  unfrcqnent.  As  mercury  v/as  the 
direct  cause,  these  cases  received  the  name  of  mercurial  stomatitis. 

In  some  of  these  cases  of  mercurial  sore  mouth  the  gums  will 
be  swollen,  spongy  and  pale,  sometimes  bleeding  upon  slight 
pressure.  A  nasty  white  sordcs  accumulates  about  the  teeth* 
which  are  loosened,  and  2)resently  we  observe  a  white  eschar 
forming  on  the  edge  of  the  gums,  which  separating  leaves  a  foul 
ulcer.  The  child  suffers  constantly,  can  take  but  little  food,  and 
the  fetor  is  so  great  that  it  is  perceptible  in  all  parts  of  the  room. 
I  have  seen  just  such  results  from  the  Homoeopathic  use  of 
mercury. 

DiAGXOSiS. — This  disease  will  usually  be  readily  determined. 
The  child  complains  of  sore  mouth,  and  presents  a  markedly 
cachectic  appearance.  The  breath  is  fetid,  the  secretions  un- 
pleasant, the  mucous  membranes  pallid  or  livid.  Then  the  cir- 
cumscribed swelling  and  hardness  as  described  with  the  com- 
mencing ulceration,  will  be  sufficient. 

Treatment. — The  treatment  of  this  case  will  be  varied  to 
meet  the  indications,  yet  we  obtain  the  best  results  from  the  use 
of  chlorate  of  potash  and  chlorine  water,  sulphurous  acid,  sul- 
phite of  soda,  Phytolacca  or  Baptisia.  In  some  cases  quinine 
(in  malarial  regions)  is  administered  internally,  but  in  many  the 
inunction  of  quinine  once  a  day  will   answer  the  best    purpose. 


300  DISEASES   OF   CHILDREN. 

Especial  a-ttentiou  must  be  given  to  the  food  of  the  child,  which, 
of  course,  is  to  be  fluid.  Hot  milk  with  a  small  portion  of  salt, 
is  a  very  common  and  good  food  ;  beef-tea,  if  there  is  a  feeble  cir- 
culation and  muscular  feebleness;  rice  nicely  prepared  with  milk, 
tapioca,  farina,  etc.,  must  be  selected  as  occasion  requires. 

If  there  is  some  febrile  action,  small  doses  of  Aconite  can  be 
used  with  benefit.  Occasionally  the  bowels  are  sluggish  and  the 
patient  suffers  from  retention  of  feces ;  in  place  of  giving  a 
cathartic,  the  bowels  may  be  moved  by  a  stimulant  enema. 

The  points  of  ulceration  I  touch  with  nitric  acid,  being  care- 
ful to  reach  all  the  parts  involved.  I  use  the  strong  acid  with  a 
piece  of  pine  wood,  so  shaped  as  to  be  most  easily  applied. 
There  is  no  trouble  or  danger  in  the  use  of  this,  if  the  precau- 
tion is  used  of  holding  it  for  a  moment  until  any  free  acid  has 
disappeared.  The  application  should  be  thorough,  both  for  the 
purpose  of  arresting  the  spread  of  ulceration  at  once,  and  to 
prevent  the  pain  of  frequent  applications.  Sometimes  one  will 
be  sufficient,  at  other  times  it  will  have  to  be  repeated  for  three 
or  four  days.  In  addition  to  this  cauterization,  the  mouth  should 
be  washed  with  an  infusion  of  Baptisia,  or  of  the  Ruraex,  Alnus, 
and  Quercus,  heretofore  named.  These  will  sometimes  be  found 
better  than  the  chlorate  of  potash,  so  commonly  used. 

SORE  THROAT. 

"V7e  have  no  technical  term  that  will  answer  to  designate  the 
different  lesions  that  are  grouped  together  under  the  name  of 
sore  throat.  The  situation  of  the  disease  varies  in  different  cases. 
In  some  the  inflammation  is  of  the  fauces,  tonsils,  and  base  of 
the  tongue,  in  others  it  is  of  the  pharynx  proper,  and  in  others 
still,  it  involves  the  posterior  nares,  the  velum,  and  to  some  ex- 
tent, the  larynx.  The  character  of  the  disease  also  varies  in 
different  cases.  In  some,  it  seems  scarcely  more  than  an  irrita- 
tion. In  others,  it  is  an  acute  erythmatous  inflammation.  In 
others,  the  deeper  tissues  are  involved,  and  there  is  considerable 
swelling.  And  in  still  others,  the  inflammation  progresses  to 
change  of  structure  and  ulceration. 

Causes. — The  most  common  cause  of  sore  throat  is  cold, 
though  we  can  give  no  reason  why  it  should  so  frequently  affect 
the  throat.  In  some  cases,  it  seems  to  be  associated  with  gastro- 
intestinal irritation. 


SORE  THROAT.  301 

Symptoms. — ^Ye  determine  the  existence  of  sore  throat  in  the 
nursing  child,  by  the  uneasiness  and  evident  pain  as  it  nursesi 
and  swallows.  Sometimes  it  will  refuse  the  breast  on  this 
account.  Usually  the  child  is  more  or  less  feverish,  is  irritable, 
sleeps  poorly,  and  wants  to  drink  frequently,  though  to  swallow 
the  water  occasions  pain.  The  throat  becomes  dry,  and  is  the 
principal  reason  for  the  craving  for  drink. 

On  examination  we  find  the  throat  presents  evidences  of  in- 
flammation, in  its  redness,  dryness,  and  heat.  It  is  not  always 
that  we  can  make  a  satisfactory  examination  of  the  throat,  and 
we  will  have  to  be  satisfied  from  the  redness  observed  about  the 
base  of  the  tongue  and  fauces. 

Treatment. — The  simple  sore  throat  of  childhood  yields 
readily  to  simple  treatment.  The  patient  is  placed  upon  the  use 
of  Aconite,  with  Phytolacca,  in  the  usual  doses,  which  are  con- 
tinued every  hour,  until  all  evidence  of  the  disease  has  disap- 
peared. The  child  has  a  hot  mustard  foot-bath  once  or  twice 
daily,  and  occasionally  a  general  bath.  The  local  application  to 
the  throat  externally  is,  where  one  is  necessary,  a  flannel  cloth 
wrung  out  of  cold  vinegar,  with  a  dry  one  over  it.  If  there  is 
some  hoarseness  the  Stillingia  liniment  is  advisable. 

The  young  child  can  not  use  a  gargle,  indeed,  it  is  almost  use- 
less until  they  reach  the  age  often  or  twelve  years.  In  its  stead, 
if  anything  is  necessary  order  the  remedy  in  this  form :  I^ 
Powdered  Gum  Arabic,  Loaf  Sugar,  Chlorate  of  Potash,  aa. 
make  powders  of  five  grains,  and  direct  that  they  be  put  upon 
the  child's  tongue  dry,  and  dissolved  by  the  secretions  of  the 
mouth,  slowly  swallowed.  These  may  be  repeated  as  often  as 
every  hour,  and  will  generally  answer  the  purpose  well.  In 
older  persons,  a  gargle  of  chlorate  of  potash,  of  sulphite  of  soda, 
of  Baptlsia,  or  of  Hydrastis,  may  be  used  with  success. 

When  the  disease  is  severe,  and  requires  more  prompt  relief,  I 
direct  that  an  inhalation  of  the  vapor  of  water,  or  water  and 
vinegar,  be  used.  If  no  apparatus  for  inhalation  is  convenient, 
we  may  employ  the  means  found  in  every  house;  sometimes 
sprinkling  the  fluid  on  a  heated  shovel  or  iron  will  answer,  the 
child  being  placed  in  such  position  that  the  vapor  may  be  inhaled. 
A  better  plan  is  to  heat  the  fluid  in  a  tin  or  other  vessel,  and 
place  it  near  the  child,  throwing  a  light  blanket  or  shawl  over 
it  and  the  child's  head  ;  a  hot  iron  is  gradually  put  in  the  fluid, 


302  DISEASES   OF   CIIILDIiEX. 

raising  the  necessary  quantity  of  steam.  Occasionally  the  inhala- 
tion may  be  medicated  with  advantage ;  an  infusion  of  Baptisia, 
of  Hamamelis,  or  of  tansy  from  the  garden,  will  answer  a  good 
purpose 

CYNANCHE  MALIGNA. 

Malignant  sore  throat  usually  prevails  as  an  endemic,  some- 
times as  an  epidemic,  and  occurs  most  frequently  in  the  winter 
and  spring.  The  cause  is  somewhat  obscure.  For  some  reason 
the  tissues  of  the  throat  are  weakened,  and  a  low  grade  of 
inflammation  is  set  up.  There  is,  doubtless,  blood  poisoning,  as 
we  observe  in  analogous  cases. 

Pathology. — There  is  a  low  grade  of  inflammation,  of  which 
malignant  sore  throat  and  epidemic  dysentery  are  examples,  that 
most  frequently  has  its  origin  in  some  local  miasm,  animal  or 
vegetable,  which  affects  the  atmosphere  of  limited  portions  of 
country.  All  the  symptoms  point  to  a  poisoning  of  the  blood, 
and  depravation  of  this  fluid,  and  consequently  of  the  secretions, 
and  of  nutrition,  as  one  of  the  principal  elements  of  the  disease. 
The  local  disease,  however  severe,  would  not  occasion  uneasiness, 
if  the  general  health  was  good,  but  with  depravation  of  the  fluids 
and  solids,  and  the  attendant  prostration,  the  disease  becomes 
one  of  the  severest  we  are  called  to  treat. 

Symptoms. — For  two  or  three  days,  sometimes  for  a  week,  it 
is  noticed  that  the  child  looks  pallid,  its  skin  waxy  or  pasty, 
and  that  there  is  a  want  of  expression  in  the  countenance  and  of 
energy  in  play.  The  breath  is  also  bad,  the  tongue  broad  and 
pale  and  somewhat  loaded.  The  child's  appetite  is  variable,  it 
rejects  its  breakfast,  but  eats  dinner  or  supper.  Frequently  it 
refuses  its  usual  food,  and  wants  sweets  and  fruit.  For  a  day  or 
two,  in  some  cases,  it  complains  some  of  its  throat. 

In  some  cases  the  disease  is  fully  announced  by  a  chill,  of 
lon,£Ter  or  shorter  duration.  But  in  others  there  is  such  a  gradual 
increase  in  the  symptoms  that  it  is  difficult  to  separate  the  form- 
ing stage  from  the  fully  developed  disease. 

When  the  physician  is  called  he  finds  evidences  of  a  general 
and  a  severe  local  disease.  The  pulse  is  soft,  easily  compressed, 
and  increased  in  frequency  from  ton  to  thirty  beats  per  minute. 
The  extremities  are  kept  warm  wnth  difficulty,  the  skin  is  pallid 


CYXA^XHE   MALIGNA.  303 

or  sallow,  and  presents  a  peculiar  waxy  appearance,  looking 
many  times  as  if  it  was  oedematous,  and  would  pit  on  pressure. 
The  face  is  pallid  and  expressionless,  with  a  dark  line  under  the 
eyes,  which  also  are  dull,  with  dilated  pupils.  The  bowels  are 
irregular,  the  feces  clay-colored  and  papescent ;  the  urine  free, 
pale,  and  of  low  specific  gravity.  There  is  no  appetite;  indeed, 
from  the  condition  of  the  mouth  aud  throat,  there  is  disgust  for 
food. 

On  examining  the  mouth  and  throat  we  find  the  mucous  mem- 
branes pallid,  the  tongue  broad,  pitting  where  it  comes  in  con- 
tact with  the  teeth,  aud  covered  with  a  pasty,  white  coat.  The 
mucous  membrane  of  the  throat  is  swollen  and  discolored ;  in 
some  cases  it  is  livid,  in  others  of  a  dusky-red,  and  in  some  few 
it  presents  a  peculiar  blanched  appearance.  The  tissue  seems 
relaxed  and  flaccid,  and  the  circulation  sluggish. 

In  a  couple  of  days  small  points  of  ulceration  will  be  seeuj 
sometimes  superficial,  at  others  with  a  tendency  to  extend  in 
depth.  These  ulcers  increase  in  size  more  or  less  rapidly,  accord- 
ing to  the  severity  of  the  disease,  and  the  throat  will  present  a 
remarkably,  ragged  and  foul  appearance.  In  very  severe  cases 
the  ulcers  pass  through  the  mucous  membrane  and  invade  the 
cellular  tissue,  so  that  in  fatal  cases  the  structures  are  destroyed 
to  a  greater  extent  than  we  would  deem  compatible  with  life,  for 
some  hours  before  death  ensues. 

A  distinctive  symptom  of  malignant  sore  throat  is  the  change 
in  the  tone  of  the  voice;  it  is  not  so  much  hoarse  as  hollow  and 
sepulchral — as  a  musician  would  say,  "  it  has  lost  its  timbre." 

Diagnosis. — This  disease  is  readily  recognized  by  the  fetid 
breath,  the  abundant  secretion  from  the  throat  and  mouth,  and 
by  the  peculiar  relaxed  condition  of  the  structures.  Add  to  this 
the  general  cachexia,  which  is  peculiar  to  this,  and,  to  some  ex- 
tent, to  cancrum  oris,  and  we  have  a  grouping  of  symptoms  that 
can  not  be  mistaken. 

Prognosis. — Though  the  disease  is  a  very  unpleasant  one,  and 
attended  with  such  depravation  of  the  fluids  and  solids,  the 
prognosis  is  not  unfavorable.  A  large  majority  of  cases  will 
recover,  probably  as  much  as  ninety  or  ninety-five  per  cent. 

Trratment. — The  treatment  of  cynanche  maligna  will  be 
both  constitutional  and  local.     We  want  to  antagonize  the  septic 


304  DISEASES   OF   CHILDREN. 

influence,  improve  the  circulation  of  the  blood,  increase  the  tone 
of  the  system,  and  place  the  stomach  in  condition  to  receive  and 
appropriate  food,  and  re-establish  secretion. 

Aconite  and  Belladonna  may  be  given  in  small  doses,  to  im- 
prove the  circulation,  or  if  the  cervical  glands  are  enlarged  Phy- 
tolacca takes  the  place  of  the  Belladonna.  Under  their  influence 
we  find  the  pulse  becoming  stronger  and  more  full,  the  capillary 
circulation  better,  and  the  temperature  of  the  body  more  uniform. 

Of  the  antiseptics  I  prefer  sulphite  of  soda  in  the  majority  of 
cases,  giving  it  in  the  usual  doses,  every  three  hours.  In  some 
cases  chlorate  of  potash  may  be  used  instead,  or  alternated  with 
the  sulphite.  Triturated  with  gum  arabic  and  sugar,  as  named 
for  diphtheria,  will  probably  be  the  best  form  of  administration. 
The  Baptisia  in  infusion  is  an  excellent  antiseptic,  and  may  be 
associated  with  either  of  them. 

In  addition  to  this,  I  prescribe  quinine  in  stimulant  doses, 
sometimes  alone,  at  others  in  combination  with  Hydrastine.  The 
dose  will  be  aboui  one-half  grain,  three  or  four  times  a  day. 
Tincture  of  muriate  of  iron  can  also  be  used  with  advantage  in 
some  cases.  It  may  be  specially  named  as  an  important  remedy 
in  those  cases  which  manifest  an  erysipelatous  tendency. 

The  local  means  will  vary  in  different  cases.  In  the  milder 
ones  a  decoction  of  Baptisia,  used  as  a  gargle,  will  be  sufficient. 
In  others  we  may  alternate  this  with  a  gargle  of  chlorate  of 
potash,  and  in  others  the  sulphite  of  soda  will  answer  a  good 
purpose.  In  those  cases  where  the  tissues  are  relaxed,  and  the 
ulceration  progressing  rapidly,  the  sulphurous  acid  will  be  the 
most  powerful,  as  well  as  the  most  certain  local  remedy  we  can 
use.  We  would  make  the  solution  of  the  strength  of  one  ounce 
of  the  acid  to  three  ounces  of  water.  When  it  is  used  with  a 
pencil  or  probang  it  may  be  applied  of  full  strength. 

But  gargles  can  only  be  used  with  children  who  have  attained 
to  six  or  ten  years,  and  in  younger  children  we  will  have  to  de- 
pend upon  other  means.  Of  course,  the  sulphite  of  soda,  chlorate 
of  potash,  and  Baptisia,  can  be  so  employed  as  to  get  their  topical 
action,  as  they  are  taken.  I  do  not  like  the  use  of  the  probang, 
or  the  smah,  to  make  local  a]ipHcations  to  the  throat  of  children. 
Instoad  of  tliis  I  use  inhalation,  ])reforriiig  the  spray  apparatus, 
either  air  or  steam,  to  any  other  ajiparatns.  But  it  does  not  re- 
quire an  instrnmcnt,  for,  as  we  have  alivady  shown,  an  inhahi- 
tion  can  be  given  with  nothing  but  a  vessel  to  hold  tlie  fluid  aii-l 


CHRONIC  SORE   THROAT.  ,  305 

a  Ilea  ted  iron  to  raise  a  vapor.  The  vapor  of  vinegar  and  water 
answers  an  excellent  purpose,  as  does  an  infusion  of  tansy,  or  of 
Baptisia.  In  using  the  spray  apparatus,  I  use  the  same  remedies 
named  for  gargles. 

The  external  application  in  this,  as  in  many  other  diseases  of 
the  throat,  is  a  flannel  wrung  out  of  cold  vinegar,  with  a  dry 
flannel  over  it.  We  call  it  the  vinegar  pack,  but  a  cold  water 
pack  to  the  throat  will  answer  the  purpose. 

CHRONIC   SORE    THROAT. 

We  are  not  accustomed  to  think  of  chronic  disease  in  child- 
hood, and  yet  we  have  many  that  are  as  strictly  so  as  any  disease 
of  the  adult.  Among  these  is  a  chronic  sore  throat,  which  is 
very  troublesome,  and,  like  other  chronic  diseases,  manifests  no 
tendency  to  recovery. 

Causes. — It  is  sometimes  difficult  to  determine  the  cause  of 
this  disease.  In  all  cases,  I  believe,  it  will  be  found  associated 
with  a  scrofulous  cachexia,  or  at  least  a  tendency  to  disease  of 
mucous  structures.  With  such  tendency  as  this,  all  that  is  neces- 
sary is  that  from  cold  or  gastric  irritation  a  simple  inflammation 
of  the  throat  be  set  up.  This  continues  on  until  it  produces  the 
condition  we  are  considering. 

Pathology. — As  just  named,  there  is  almost  invariably  a 
cachectic  condition  of  the  system,  a  tendency  to  disease  of  this 
character,  which  will  manifest  itself  in  different  tissues,  as  they 
may  suifer  from  some  acute  irritation  or  inflammation.  Such 
children  rarely  live  to  adult  years,  and  furnish  subjects  for  the 
various  forms  of  scrofula,  hip-joint  disease,  white  swellings,  and 
finally  phthisis.  True  this  predisposition  may  be  removed  by  a 
judicious  and  long  continued  course  of  training,  but  it  is  rarely 
adopted. 

Symptoms. — The  attention  will  be  drawn  to  the  throat  as  the 
seat  of  disease,  by  continually  recurring  attacks  of  slight  sore 
throat.  Sometimes  it  will  seem  to  involve  the  respiratory  organs 
more;  there  will  be  a  hacking  cough,  frequent  endeavors  to  clear 
the  throat,  and  slight  difficulty  in  respiration.  With  such  at- 
tacks the  child  is  fretful,  and  has  slight  fever. 

20 


306  DISEASES   OF   CHILDREN. 

We  notice  it  at  all  ages,  from  three  months  old  to  the  close  of 
life,  and  it  presents  somewhat  similar  symptoms.  The  evidences 
of  general  cachexia  will  vary  in  different  cases,  sometimes  being 
marked,  while  at  others  the  child  seems  quite  healthy. 

Upon  examination  of  the  throat  we  find  the  mucous  membrane 
relaxed  and  thickened,  the  mucous  follicles  enlarged,  and  the 
circulation  sluggish.  There  is  also  change  in  the  color  of  the 
parts;  they  have  become  a  dirty-red,  dusky,  livid,  but  more  fre- 
quently a  pallid  red.  The  tonsils  are  frequently  enlarged,  and 
the  mucous  follicles  about  the  base  of  the  tongue  are  also  en- 
larged, and  keep  the  part  constantly  covered  with  their  secretion. 

In  very  bad  cases  the  throat  presents  a  peculiar  appearance ; 
the  pillars  of  the  fauces  seem  thickened,  as  is  the  velum  and 
uvula,  and  with  the  enlarged  tonsils,  present  a  misshapen  ap- 
pearance. The  voice  in  this  case  has  changed,  becoming  fivffy 
or  hollow,  and  lacks  distinctness  in  articulation. 

Treatment. — When  the  child  presents  evidence  of  a  scrofu- 
lous cachexia,  we  proceed  to  treat  that  as  named  for  scrofula. 
Usually  it  is  not  so  marked,  and  our  treatment  will  be  a  tonic 
and  restorative  general  treatment. 

The  tonic  for  a  child,  as  I  have  had  occasion  to  name  several 
times,  is  tincture  of  muriate  of  iron,  with  cod-liver  oil  if  the 
child  will  take  it.  We  make  the  usual  prescription  :  ^  Tincture 
of  Muriate  of  Iron  5j-j  Glycerine  5iv.,  a  teaspoonful  three  times 
a  day.  If  the  appetite  is  poor,  or  there  is  an  infantile  dyspepsia, 
a  small  portion  of  tincture  of  Nux  Vomica  may  be  added  to  it. 

A  very  good  means  in  this  case  is  the  use  of  ColHnsonia.  For 
a  child  two  years  old,  I  would  prescribe:  ^  Fluid  Extract  of 
ColHnsonia  Sss.,  Simple  Syrup  §iv.,  a  half  teaspoonful  every 
four  hours.  If  the  child  is  old  enough  to  gargle  the  throat,  I 
direct  an  infusion  of  Hamamelis,  or  the  fluid  extract,  in  the  pro- 
portion of  one-half  ounce  to  six  ounces  of  water. 

The  vinegar  pack  to  the  throat,  with  the  cold  sponging  in  the 
morning,  is  an  important  part  of  the  treatment.  As  is  the  case 
with  all  other  chronic  diseases  of  the  throat  and  larynx,  the 
patient  seems  to  be  continually  taking  cold,  and  this  prevents 
that  continuous  amendment  necessary  to  complete  recovery.  The 
use  of  the  pack,  even  of  cold  water,  with  the  cold  sponging  of  the 
neck  and  shoulders,  is  the  most  efficient  means  to  prevent  this. 


GASTRODYNIA.  307 

GASTHODYNIA. 

I  use  the  term  gastrodynia  to  express  the  condition  of  pain  in 
the  stomach,  whether  the  pain  is  the  result  of  irritation  of  the 
gastric  nerves,  ftom  cold,  from  irritative  ingesta,  or  from  spas- 
modic contraction  of  the  muscular  coat.  In  slight  degree  it  is 
of  very  frequent  occurrence,  and  is  quite  often  seen  in  a  severe 
form.  With  some  children  it  is  of  daily  recurrence,  and  is 
usually  called  colic  by  mothers  and  nurses.  It  not  only  causes 
much  suffering  to  the  child,  but  is  source  of  very  great  annoy- 
ance to  the  parents ;  and  when  the  mother  is  in  feeble  health,  it 
becomes  a  serious  matter,  and  if  possible  must  be  removed. 

Causes. — The  most  common  cause  of  pain  in  the  stomach  is 
indigestion.  The  child  nurses  well,  and  frequently  thrives,  but 
some  portion  of  the  food  undergoes  decomposition  and  proves 
irritant,  or  generates  gas  which  unduly  distends  the  stomach.  In 
some  of  these  cases  there  seems  to  be  a  peculiarly  irritable  condi- 
tion of  the  gastric  nerves,  so  that  a  very  slight  cause  is  sufficient 
to  produce  pain.  In  other  cases  it  results  from  cold,  and  in  these 
there  is  fever ;  and  in  others  there  is  a  real  spasmodic  action,  or 
cramp  of  the  stomach. 

Symptoms. — The  child  exhibits  evidences  of  pain  in  its  coun- 
tenance, is  uneasy,  and  will  not  remain  in  one  position,  and  has 
violent  paroxysms  of  crying.  In  some  cases  the  body  is  drawn 
up,  and  the  lower  extremities  are  flexed  upon  the  abdomen. 
Occasionally  there  are  eructations  and  some  of  the  food  is  thrown 
up,  showing  imperfect  digestion  ;  but  at  other  times  the  milk  will 
be  curded  and  sweet,  showing  healthy  digestion. 

In  the  majority  of  cases  the  pain  is  paroxysmal,  lasting  for 
five  or  ten  minutes,  during  which  the  child  seems  to  suffer 
severely,  and  cries  violently;  it  gradually  abates  until  there  is 
comparative  ease,  and  as  we  are  about  to  congratulate  ourselves 
that  the  pain  has  wholly  passed  away  another  paroxysm  comes 
on  suddenly.  Thus  it  may  continue  for  an  hour  or  two,  or  for  a 
considerable  portion  of  a  day. 

Treatment. — In  many  cases  we  find  one  or  two  drops  of 
tincture  Nux  to  a  half  glass  of  water,  given  in  half  teaspoonful 
doses,  every  fifteen  minutes  to  one  hour,  will  give  speedy  relief. 


308  DISEASES   OF    CHILDREN. 

If  there  is  irritation  of  the  bowels,  also  with  griping  pain,  Tinet. 
Colocynth  gtt.  j.  to  gtt.  ij.  to  water  oiv.,  a  teaspoonful  every  half- 
hour  to  hour  will  give  speedy  relief.  In  some  cases  Aconite 
may  be  used  with  both  of  these,  and  aids  in  relieving  the  pain* 
Dioscorea  in  infusion,  the  tincture  gtt.  v.  to  gtt.  x.,  to  water  Siv., 
is  a  good  remedy.  Apis  answers  a  good  purpose  when  the  pain 
in  the  stomach  is  associated  with  an  eruption  like  "heat,"  and 
Belladonna,  if  such  an  eruption  has  disappeared  from  the  surface. 
The  old  remedies,  after  the  following  formula,  may  sometimes  be 
given:  ^  Tincture  of  Lobelia  5j-,  Compound  Tincture  of  Lav- 
ender Siijv  Simple  Syrup  ojss. ;  the  dose  will  be  from  one-fourth 
to  one  teaspoonful,  and  may  be  repeated  as  often  as  necessary. 
Another  excellent  preparation  is :  I|i  Chloroform  gtt.  xx., 
Glycerine  Sijv  in  doses  of  one-fourth  to  one  teaspoonful,  as  often 
as  required. 

When  these  attacks  are  of  frequent  occurrence  in  nursing 
children  we  may  suspect  a  wrong  in  the  mother's  diet  or  diges- 
tion, and  this  being  looked  after,  we  will  sometimes  find  that  our 
little  patient  has  more  comfort.  In  other  cases  the  pain  is  a 
symptom  of  infantile  dyspepsia,  and  lime-water,  phosphate  of 
soda,  or  some  of  the  simpler  tonics,  will  give  permanent  relief. 

The  best  local  application,  as  a  general  rule,  will  be  a  hot  dry 
flannel  applied  over  the  stomach  and  abdomen.  Sometimes  the 
use  of  the  hot  flannel  to  the  spine  will  give  speedier  relief  than 
when  used  over  the  stomach.  In  children  of  one  year  and 
older  a  mustard  plaster  may  be  used. 

GASTRIC  IRRITATION. 

We  are  called  to  prescribe  for  cases  in  which  there  is  marked 
irritation  of  the  stomach.  It  occurs  as  a  complication  of  many 
acute  diseases,  and  sometimes  alone,  there  being  no  other  disease 
present.  In  the  first  case  it  increases  the  severity  of  the  primary 
disease,  prevents  the  absorption  of  remedies,  and  the  taking  and 
digesting  of  food.  It  thus  becomes,  when  severe,  an  unfavorable 
complication. 

Causes. — We  can  not  determine,  in  many  cases,  any  cause  for 
this  irritation.  In  some  it  depends  upon  imperfect  digestion  of 
food,  in  others  from  cold  and  arrested  secretion.  In  acute  dis- 
ease it  is  doubtless  owing  in  part  to  decomposition  of  food,  taken 
before  the  disease  was  fairly  announced. 


GASTRIC   IRRITATION.  309 

Symptoms. — Prominent  among  the  symptoms  is  the  occasional 
nausea,  retching,  and  effort  to  vomit.  The  child  is  thirsty,  and 
desires  drink  frequently,  but  when  any  quantity  is  taken  it  is 
ejected  by  vomiting.  If  nursing,  it  wants  the  breast  frequently, 
and  after  nursing  it  throws  up  its  milk.  When  the  child  is 
weaned,  it  will  generally  reject  all  food. 

If  medicine  is  given,  at  least  many  kinds,  it  will  be  thrown  up 
after  a  time.  Thus,  in  the  treattnent  of  acute  disease,  we  may 
be  giving  the  sedatives,  or  any  remedies,  every  hour;  the  child 
takes  three  or  four  doses,  and  then  there  is  sickness  of  the 
stomach,  and  the  whole  is  ejected.  Thus,  many  times,  the  treat- 
ment will  go  on  day  after  day  without  any  appreciable  influence 
upon  the  disease,  none  of  the  medicine  having  gained  entrance 
into  the  circulation. 

In  this  condition  of  irritation  osmose  is  from  the  blood-vessels 
to  the  stomach,  and  of  course  there  is  no  absorption  either  of 
food  or  of  medicine. 

Irritation  of  the  stomach,  without  other  disease  may  continue 
for  several  davs,  or  in  slijrht  de<>:ree  for  two  or  three  weeks. 
Necessarily  there  is  sympathetic  disturbance  of  the  nervous 
system,  and  of  other  functions,  and  digestion  being  arrested  the 
child  is  much  prostrated. 

There  is  an  irritation  of  the  stomach,  arising  from  disease  of 
the  brain,  that  Is  of  very  serious  import.  This  case  is  diagnosed 
by  the  contracted  and  pinched  appearance  of  the  countenance, 
the  dullness  of  the  eyes,  and  the  increased  frequency  and  hard- 
ness of  the  pulse  (there  are  some  exceptional  cases  in  whicli  the 
pulse  is  small  and  weak).  The  skin  is  dry,  sometimes  husky, 
the  temperature  of  the  trunk  slightly  increased,  but  the  extremi- 
ties are  cold. 

If  the  tongue  Is  examined  in  irritation  of  the  stomach,  it  will 
sometimes  be  found  reddened,  contracted,  and  pointed,  in  others 
pale  and  atonic  ;  In  the  one  there  is  irritation  with  determination 
of  blood,  in  the  other  atony.  If  coated,  it  will  be  with  a  white 
fur,  confined  to  the  center. 

Treatment. — When  there  is  febrile  reaction,  or  increase  of 
temperature,  I  direct  cold  applications  over  the  epigastrium.  In 
the  opposite  cases,  a  sinapism  or  a  spice  plaster  may  be  used.  In 
all  cases  much  benefit  will  follow  the  use  of  the  hot  foot-bath, 
which,  if  the  extremities  are  inclined  to  be  cold,  maybe  rendered 
stimulant  by  the  addition  of  mustard  or  capsicum. 


310  DISEASES  OF  CHILDEEX. 

luternuliy,  if  the  tongue  is  elongated  and  red,  we  may  admin- 
ister small  doses  of  Aconite  and  Ipecac,  say  :  !^  Tiuct.  Aconite 
gtt.  j.  to  gtt.  ij.,  Tinct.  Ipecac  gtt.  v.  water  5iv.,  a  half  teaspoon- 
ful- every  hour.  If  the  pulse  is  sharp  and  the  patient  has  frontal 
headache,  the  remedies  will  be  Aconite  and  Rhus.  In  the  second 
case,  when  there  is  evidence  of  atony,  the  prescription  will  be  :  ^i 
Tinct.  Nux  gtt.  j:  to  gtt.  ij.  water  Siv.,  a  teaspoonful  every  half 
hour.  Occasionally  an  infusion  of  our  old  fashioned  compound 
powder  of  rhubarb  given  in  small  doses  will  give  relief. 

In  place  of  this,  and  better  adapted  to  severe  cases,  is  an  infu- 
sion of  the  bark  of  the  peach-tree.  We  take  the  young  and 
green  limbs  of  the  present  year's  growth,  scrape  the  bark  off, 
cover  it  with  boiling  water,  and  when  cold  it  is  ready  for  use. 
We  give  it  at  first  in  doses  of  one -fourth  to  one-half  teaspoonful 
every  few  minutes  until  the  irritation  has  partially  subsided ; 
afterwards  in  teaspoonful  doses  for  two  or  three  hours. 

Occasionally  we  will  obtain  benefit  from  the  preparations  of 
bismuth  ;  either  the  subnitrate,  carbonate,  or  liquor  bismuth  may 
be  used.  The  first  I  generally  prescribe  with  mint  water,  in 
doses  of  from  one  to  three  grains. 

When  the  irritation  is  very  persistent,  the  bowels  being  consti- 
pated, an  enema  of  a  weak  salt  water  to  move  the  bowels,  will 
aid  in  giving  relief.  If  the  temperature  is  high  the  injection 
may  be  cold,  if  the  patient  is  exhausted  the  injection  should  be 
hot.  In  these  severe  cases  we  are  very  careful  in  administering 
remedies  and  giving  food  after  the  irritation  seems  to  have  been 
subdued. 


GASTRITIS. 

Acute  inflammation  of  the  stomach  is  rarely  met  with  in  the 
child,  and  only,  as  I  believe,  from  the  administration  of  irritant 
medicines.  Subacute  inflammation,  however,  is  met  with  quite 
frequently,  and  is  sometimes  very  persistent. 

Causes. — The  causes  of  inflammation  of  the  stomach  are  two- 
fold. It  may  be  produced  by  the  ordinary  causes  of  inflamma- 
tion in  other  organs,  as  from  cold,  arrested  secretion,  etc.  It  is 
also  the  result  of  irritant  ingesta,  or  of  such  decomposition  of 
food  as  gives  rise  to  irritant  products,  or  to  irritant  secretions. 


GASTRITIS.  311 

Symptoms. — Subacute  gastritis  may  occur  as  an  idiopathic 
affection,  or  as  a  complication  of  some  other  disease.  In  tli^e  first 
case  it  is  announced  by  nausea,  retching,  and  vomiting,  following 
a  short  forming  stage,  in  which  for  a  few  hours  the  child  has 
been  restless  and  uneasy,  not  caring  for  food,  but  wanting  to 
drink  freely.  Occasionally  there  is  a  pretty  well-marked  chill 
lasting  for  an  hour  or  two. 

The  retching  and  vomiting  are  not  constant,  but  come  on  at 
longer  or  shorter  intervals,  are  quite  violent  and  attended  with 
much  straining.  "When  the  stomach  is  thus  relieved  for  the 
time  being,  the  child  seems  to  lie  easily,  and  sometimes  falls  into 
a  short  sleep.  Presently  the  thirst  increases,  it  wants  drink  con- 
tinually, and  having  taken  but  a  small  amount,  vomiting  again 
commences. 

There  is  always  more  or  less  fever.  Usually  it  is  paroxysmal, 
following  the  course  of  the  vomiting,  coming  up  after  this  has 
stopped  and  gradually  increasing  until  the  nausea  and  vomiting 
commence.  After  the  nausea  and  vomiting  have  continued  to 
relaxation,  the  fever  passes  off,  to  re-appear  again,  as  before 
named.  In  some  cases  the  nausea  and  retching  simply  increase 
the  irritation  of  the  nervous  system  and  the  circulation,  and 
there  is  no  abatement  of  the  febrile  action. 

In  some  cases  the  irritation  of  the  nervous  system  is  very  great, 
and  manifests  itself  in  uneasiness  and  restlessness,  crying  and 
other  evidences  of  suffering.  In  a  few  cases  the  irritation  is  of 
such  character  as  to  produce  convulsions,  which  are  usually  very 
severe  and  intractable. 

Should  the  gastric  irritation  not  be  arrested,  it  will  result  in 
one  of  three  ways.  In  nervous  irritation,  occasionally  convtil- 
sions,  and  finally  coma,  gradually  increasing  until  it  proves  fatal. 
In  irritation  of  the  intestinal  canal,  and  diarrhoea,  which,  running 
the  usual  course,  terminates  in  the  same  manner  as  rauco-enteritis. 
In  an  irritative  fever,  which  rapidly  assumes  typhoid  symptoms, 
and  proves  one  of  the  severest  diseases  we  are  called  to  treat. 

Treatment.— Til e  treatment  of  an  inflammation  of  the 
stomach  is  quite  simple,  and  usually  very  successful.  The  first 
object  is  to  so  modify  the  irritation  as  to  stop  nausea  and  vomit- 
ing, for  these  perpetuate  if  they  do  not  increase  the  irritation  ; 
afterward  we  have  time  for  the  removal  of  the  inflammation. 

The  patient  has  a  general  bath  if  febrile  reaction  is  high,  fol- 


312  DISEASES   OF   CHILDREN. 

lowed  by  a  hot-mustard  foot-bath,  continued  for  twenty-five  to 
thirty  minutes.  In  some  cases  a  general  hot  bath,  using  salt  in 
the  water,  will  prove  beneficial;  if  this  be  used,  the  applications 
to  the  epigastrium  should  also  be  hot.  In  the  majority  of  cases, 
I  prefer  cloths  wrung  out  of  cold  water,  over  the  stomach.  In- 
stead of  this,  a  sinapism  made  of  three  parts  of  flour  to  one  of 
mustard,  may  be  used. 

Internally  I  would  prescribe  an  infusion  of  peach-tree  bark, 
in  doses  of  one-fourth  to  one-half  teaspoonful,  frequently  repeated. 
The  infnsion  is  made  of  th-e  bark  of  the  limbs  of  the  present 
season's  growth.  In  place  of  this,  bismuth  with  mint  water  may 
be  employed,  as  named  for  irritation  of  the  stomach.  In  some 
cases,  those  especially  in  which  the  inflammation  is  not  high,  we 
may  use  the  compound  powder  of  rhubarb  in  infnsion. 

To  modify  the  febrile  action  small  doses  of  Aconite  are  em- 
ployed ;  five  drops  to  four  ounces  of  water ;  a  teaspoonful  every 
half  hour  or  hour  will  be  the  proper  quantity.  If  there  is  much 
irritation  of  the  nervous  system  we  may  give  the  Gelseminum, 
in  doses  of  from  one  to  three  drops,  with  the  sedative.  We  find 
that  these  remedies  not  only  answer  their  specific  purpose,  but 
they  also  have  a  beneficial  influence  in  arresting  gastric  irritation. 

In  some  cases  we  find  the  bowels  inactive,  and  occasionally 
the  gastric  disease  is  increased  by  accumulations  in  the  intestinal 
canal.  As  it  is  clearly  out  of  place  to  give  cathartics  by  mouth, 
we  must  depend  upon  enemas.  An  enema  of  salt  watar  will 
sometimes  exert  a  marked  influence  in  checking  nausea  and 
vomiting ;  not  so  much  in  gastritis,  of  course,  as  in  simple  irrita- 
tion of  the  stomach,  yet  its  influence  in  this  respect  is  beneficial. 
Simple  enemata  are  used  when  the  object  is  to  empty  the  lower 
bowels,  but  when  the  small  intestine  is  to  be  reached,  the  enema 
should  be  of  compound  powder  of  Jalap,  or  of  castor  oil,  in  warm 
water. 

INFANTILE    DYSPEPSIA. 

To  many  persons  the  name  infantile  dyspepsia  will  sound 
singular,  as  they  have  been  accustomed  to  think  of  dyspepsia  as 
associated  with  a  long-abused  and  v.'orn-out  stomach.  Yet  dys- 
pepsia is  a  very  common  complaint  with  tlie  child,  almost  as  fre- 
quent as  in  the  adult,  though  not  so  persistent. 

There  are  several  causes  of  infantile  dyspepsia,  and  we  will 
obtain  a  better  knowledge  of  the  disease  and  of  its  therapeutics, 


INFANTILE   DYSPEPSIA.  313 

if  we  study  these.  They  have  reference  to  the  quality  and 
quautity  of  the  food,  to  the  secretion  of  gastric  juice,  to  the 
muscular  action  of  the  stomach,  and  to  the  condition  of  the  upper 
intestinal  canal. 

We  find  this  disease  most  commonly  in  children  who  have 
other  food  than  the  mother's  milk.  Here  the  trouble  is  in  the 
difficulty  with  which  the  food  is  digested,  and  the  imperfection 
of  this  process,  in  which  some  portions  undergo  decomposition. 
This  may  be  corrected  in  some  cases,  to  a  limited  extent,  by 
changing  the  food,  by  giving  it  in  a  less  concentrated  form,  and 
in  such  manner  that  the  secretion  of  saliva  may  be  increased. 
Thus  in  a  case  where  the  child  was  being  fed  on  cow's  milk, 
simply  diluting  the  milk  with  one-fourth  water  has  proved  suc- 
cessful. Or,  when  it  was  fed  with  a  spoon,  or  from  a  cup,  the 
use  of  the  bottle,  so  as  to  call  for  the  act  of  sucking,  would 
cause  an  increased  flow  of  saliva,  and  the  little  patient  would  be 
greatly  benefited. 

A  very  common  cause  of  infantile  dyspepsia  is  over-feeding. 
This  is  the  most  common  cause  in  nursing  children,  and  depends 
not  only  upon  the  taking  of  too  large  a  quantity  at  a  time,  but 
upon  its  too  frequent  nursing.  In  the  one  case  the  stomach  is 
overdistended,  and  overworked,  and  gradually  it  loses  its  power 
of  digestion,  and  evidences  of  dyspepsia  are  manifested.  In  the 
other  case  the  stomach  is.allowed  no  repose,  in  which  to  regain 
its  lost  powers,  or  for  its  nutrition.  The  result  is  that  its  func- 
tion becomes  gradually  impaired. 

In  another  class  of  cases  the  dyspepsia  is  dependent  upon  a 
bad  blood,  from  the  many  causes  heretofore  named  for  this  de- 
terioration. The  child  is  cachectic,  lacks  power  in  every  direc- 
tion, and  this,  as  well  as  other  functions,  are  impaired. 

Dyspepsia  is  not  always  a  gastric  lesion.  The  small  intestines 
have  as  much  to  do  with  the  digestion  of  food  as  the  stomach, 
and  a  lesion  here  gives  rise  to  dyspepsia.  Generally  this,  so  far 
as  we  can  see,  is  a  simple  atony,  at  other  times  it  is  an  irritation. 
The  atony  is  not  only  of  the  small  intestine,  but  also '  of  the 
liver,  the  pancreas,  and  indeed  of  all  associated  parts.  In  such 
cases  the  circulation  of  blood  and  the  innervation  are  deficient ; 
there  is  a  want  of  normal  stimulus.  So  in  cases  of  irritation, 
the  associated  organs  are  involved,  to  a  greater  or  less  extent, 
and  there  is  too  much  blood  and  innervation  to  these  parts. 

There  are  cases  in  which  a  failure  of  power  in  the  muscular 


314  DISEASES   OF  CHILDREN. 

coat  of  the  stomach  is  a  cause  of  dyspepsia  in  infants,  as  well  as 
adults.  Others  in  which  there  is  a  defect  in  the  secretion  of 
gastric  juice,  either  in  quantity  or  quality.  These  in  the  child  are 
principally  of  an  atonic  character,  and  hence  there  will  not  be  so 
much  difficulty  in  the  treatment  as  in  the  disease  of  the  adult. 

Symptoms. — The  symptoms  of  dyspepsia  in  the  child  vary 
greatly  ;  in  some  cases  being  well  marked,  in  others  obscure. 
Usually  the  child  is  uneasy  after  taking  its  food,  and  is  fre- 
quently troubled  with  colic.  Vomiting  of  the  food  is  of  common 
occurrence,  and  it  the  matters  ejected  are  examined,  the  food  will 
be  found  acid,  smelling  sour  and  sickly,  or  undergoing  incipient 
decomposition.  These  changes  in  the  matter  ejected  are  pathog- 
nomonic; for  in  the  vomiting  which  follows  mere  repletion,  in 
which  case  the  overloaded  stomach  takes  this  easy  mode  of  re- 
lieving itself,  the  food  is  sweet,  the  milk  well  curded,  presenting 
evidences  of  a  healthy  condition  of  digestion. 

With  this  digestive  lesion  we  notice  that  the  child  becomes 
pale,  the  tissues  soft  and  flabby,  the  circulation  feeble  and  the 
extremities  cold.  There  is  also,  in  most  cases,  very  marked  irri- 
tation of  the  nervous  system,  the  child  being  restless,  irritable, 
and  fretful,  and  at  night  tosses  about,  awakes  frequently,  and 
wants  to  drink. 

In  some  cases  there  is  the  same  desire  for  food,  even  a  ravenous 
appetite  at  times.  In  other  cases  the  appetite  slowly  fails,  and 
the  child  cries  neither  for  food  nor  for  the  breast.  When  this 
form  continues  for  any  considerable  time,  the  child  becomes 
anseraic  and  much  debilitated. 

The  simplest  division  of  these  cases  is  into  the  irritative  and 
atonic.  In  the  first  case  the  evidence  of  gastric  irritation  is  pretty 
well  marked.  There  is  the  red  tongue,  the  irritability  of  the 
nervous  system,  the  pinched  face,  and  bright  eyes,  the  harsh  skin, 
and  the  greenish  acrid  discharges  from  the  bowels. 

In  the  atonic  form  of  dyspepsia,  the  tongue  pale,  a  whitish  pasty 
fur  accumulates  at  its  base,  the  breath  has  a  sickly  odor,  the  child 
is  feeble  and  languid,  and  likes  to  remain  in  one  position,  the 
face  is  pallid,  the  eyes  dull,  the  face  expressionless,  the  skin  soft, 
relaxed,  and  cool,  the  j)\\he  soft  and  feeble,  and  the  discharges 
from  the  bowels  light-colored. 

Diagnosis — Tlie  diagnosis  will  be  made  in  part  by  the  syinj)- 
toms  above-named,  which  point  to  the   stomach  as   the  seat  i)f  a 


INFANTILE   DYSPEPSIA.  315 

lesion,  and  in  part  by  exclusion.  The  difference  in  the  diagnosis 
between  the  adult  and  the  child  is,  that  the  first  points  out  the 
location  of  the  unpleasant  sensations,  while  in  the  second  we  have 
to  determine  this  by  careful  observation.  By  making  the  ex- 
amination thorough  we  are  enabled  to  exclude  one  organ  after 
another  until  the  evidence  of  the  gastric  lesion  becomes  positive. 

Prognosis. — The  prognosis  is  not  always  favorable.  It  will 
depend  much  upon  the  kind  of  food  the  child  is  taking;  if  nurs- 
ing, it  is  favorable;  if  fed  on  cow's  milk  or  other  food,  it  is  un- 
favorable. It  is  generally  grave  in  proportion  to  the  change  in 
the  matters  vomited ;  if  they  are  but  little  changed,  or  seem  to 
be  undergoing  the  process  of  digestion  in  a  proper  manner,  we 
conclude  that  the  lesion  of  the  stomach  is  simple  in  its  nature. 
But  if  they  are  undergoing  decomposition,  and  have  an  unpleas- 
ant odor,  the  evidence  of  serious  lesion  is  pretty  strong. 

Treatment. — The  first,  thing  that  engages  the  attention  of  the 
])hysician  is  the  food  of  the  child,  for  as  we  have  seen  above,  the 
lesion  is  frequently  dependent  upon  a  wrong  in  this.  If  the 
child  is  being  raised  on  cow's  milk,  or  other  artificial  food,  we 
will  see  that  this  is  the  best  of  the  kind,  and  properly  prepared 
and  given.  When  the  dyspepsia  is  persistent  we  will  have  to 
take  into  consideration  the  propriety  of  changing  it.  Liebig's 
food  will  answer  a  good  purpose  in  many  of  such  cases,  when 
the  child  is  being  fed  upon  milk.  The  directions,  heretofore 
given  under  the  head  of  food  for  the  child,  may  be  studied  with 
advantage. 

When  the  child  is  nursing  we  will  inquire  as  to  the  mother's 
diet,  for  not  unfrequently  indiscretions  upon  her  part  will  have 
caused,  and  may  perpetuate,  the  disease.  Usually  it  is  the  use 
of  vegetables  and  fruits  in  too  large  quantity  that  has  first  oc- 
casioned it.  In  some  cases  the  dyspeptic  lesion  of  the  child  de- 
pends upon  a  similar  gastric  lesion  upon  the  part  of  the  mother, 
and  it  is  her  imperfect  digestion  which  deranges  its  stomach. 

In  case  of  indiscretions  in  diet,  we  will  represent  the  import- 
ance of  care  in  this  regard  ;  and  when  this  is  not  so  manifest  it 
will  be  well  to  change  the  mother's  food  until  we  have  discovered 
what  was  giving  rise  to  the  trouble.  When  the  mother  suffers 
from  dyspeptic  symptoms,  or  has  imperfect  or  feeble  digestion,  it 
will  be  proper  to  put  her  upon  a  course  of  treatment  that  will 
restore  the  functions  of  the  stomach. 


316  DISEASES   OF  CHILDREN. 

A  very  marked  case  of  this  kind  came  under  my  eaie  iu  the 
earlier  part  of  my  practice.  A  lady  had  given  birth  to  five 
children,  of  which  three  had  died  of  infantile  dyspepsia.  One 
was  saved  by  weaning,  and  the  fifth,  at  the  age  of  three  months, 
was  suffering  severely.  I  treated  the  mother  for  chronic  gastritis, 
by  the  use  of  the  Irritating  plaster  over  the  stomach,  and  an  in- 
fusion of  hydrastis  taken  internally,  and  as  the  irritation  disap- 
peared added  iron  and  phosphorus.  As  the  gastric  symptoms  of  the 
mother  disappeai*ed  and  her  health  improved,  the  child  became 
better,  and  in  a  few  weeks  was  doing  as  well  as  other  children. 

In  some  cases  we  will  have  to  take  into  consideration  the 
propriety  of  weaning  the  child,  as  it  becomes  evident  that  the 
disease  can  not  be  controlled  otherwise.  In  some,  feeding  the 
child  with  cow's  milk  is  attended  with  benefit,  though  in  others 
the  child  rapidly  fails  after  it  is  put  upon  it.  Liebig's  food, 
when  the  child  will  take  it,  usually  does  well.  When  artificial 
food  disagrees  with  the  child  it  increases  the  pains  in  the  bowels, 
and  is  either  vomited  or  is  carried  off  by  a  diarrhoea.  In  all 
such  cases  the  chances  of  saving  the  child  is  much  better  if  a 
suitable  wet-nurse  can  be  obtained,  and  this  should  be  clearly 
stated  to  the  parents  at  as  early  a  period  as  possible. 

In  some  cases  the  employment  of  restoratives  and  tonics  with 
the  mother,  and  the  use  of  well-cooked  animal  food,  will  be  the 
best  treatment  for  the  child.  Tincture  of  muriate  of  iron  a^d 
glycerine,  with  the  addition  of  tincture  of  Nux  Vomica,  if  there 
is  atony  of  the  stomach,  answers  very  well.  Hydrastis,  with 
same  preparation  of  iron,  is  a  good  bitter  and  stomachic.  The 
hypophosphites  have  proven  serviceable  in  my  practice,  either 
singly  or  in  the  form  of  compound  syrup  of  the  hypopliospliites. 

In  some  of  the  more  simple  forms  of  infantile  dyspe|).sia  we 
will  find  the  administration  of  phosphate  of  soda  in  small  doses, 
three  or  four  times  a  day,  either  alone  or  with  the  food,  mmU 
answer  an  excellent  purpose  (about  ten  grains  daily  for  a  child 
three  to  six  months  old).  Common  salt  will  also  exert  a  marked 
beneficial  effect  with  nursing  children,  in  some  of  these  cases. 

Where  the  dyspepsia  is  of  the  irritative  form,  I  prescribe  an 
infusion  of  peach  bark,  as  heretofore  named,  and  some  preparation 
of  bismuth.  The  snbiiitrate  or  subcarbonate  in  powder,  or  the 
liquor  bismuth,  in  small  doses.  With  these,  and  proper  hygienic 
means,  the  irritation  will  have  so  abated  in  one  or  two  weeks,  the 
child   can  be  put  upon  the  use  of  Collinsonia  and  tincture   of 


COLIC,  317 

muriate  of  iron.  Where  there  is  evidently  accumulations  in  the 
small  intestine,  an  infusion  of  the  compound  powder  of  rhubarb, 
given  to  produce  its  laxative  effect,  may  precede  the  other 
remedies. 

In  some  cases  of  irritative  dyspepsia  we  will  obtain  much 
advantage  from  the  use  of  small  doses  of  Aconite,  repeated  every. 
one  or  two  hours  for  a  day  or  two,  and  afterward  at  less  frequent 
intervals.  The  wet  pack  to  the  abdomen  may  also  be  resorted  to 
in  more  acute  cases  with  advantage. 

In  the  simpler  forms  of  atonic  dyspepsia,  I  put  the  child  on 
the  use  of  some  simple  bitter,  as  an  infusion  of  Matricaria  Chamo- 
milla,  Virginia  snake  root,  or  the  Panax  Quinquefolia.  In 
others  I  prescribe  Collinsonia  alternated  with  tincture  of  muriate 
of  iron  in  the  following  proportions:  I^  Tincture  of  Collinsonia 
Sss.,  Simple  Syrup  .5iijss. ;  half  a  teaspoonfnl  three  times  a  day. 
Bs  Tincture  of  Muriate  of  Iron,  S'j-,  Glycerine,  Simple  Syrup,  aa. 
to  oiv. ;  a  teaspoonful  three  times  a  day.  The  tincture  of  Nux 
Vomica  in  small  doses,  or  a  solution  of  strychnia  in  doses  of 
about  the  l-200th  to  the  1-lOOth  of  a  grain  may  be  used  with 
marked  advantage. 

In  some  of  these  cases  Podophyllin,  thoroughly  triturated,  will 
prove  one  of  our  best  remedies.  As  named  in  the  first  part,  it 
should  be  triturated  in  the  proportion  of  one  part  to  ten  or 
twenty  of  sugar ;  have  Ipecac  triturated  in  the  same  way,  and 
combine  them  in  equal  parts,  making  powders  of  one-half  to  one 
grain.  This  may  be  given  three  or  four  times  a  day,  and  asso- 
ciated with  the  tonics,  as  before  named. 

COLIC. 

We  may  distinguish  two  forms  of  colic  in  children,  the  one 
being  temporary  and  arising  from  slight  indigestion,  the  other 
bearing  a  close  relationship  to  the  bilious  colic  of  the  adult,  and 
due  to  spasmodic  contraction  of  the  muscular  coat. 

The  first  form  is  of  very  frequent  occurrence,  and  in  some 

cases  seems  to  be  natural  to  the  child.     It  comes  on   from  the 

slightest  causes,  and  lasting  an  hour  or  two,  passes  away,  and 

the  child  seems  as  well  as  ever.     With  many  it  will  continue  to 

recur  frequently  for  the  first  three  or  four  months,  and  will  then 
cease. 

The  second  form  of  colic  is  caused  by  cold,  by  indigestion,  by 
some  indiscretion  in  the  diet  of  the  mother,  or  occasionally  by 


318  .  DISEASES   OF    CHILDRE]^^. 

mental  excitement,  from  anger,  fear,  grief,  etc.  The  child  not 
only  suffers  much  pain,  but  there  is  functional  disturbance,  and 
some  fever. 

Symptoms. —  In  either  form  of  colic  the  child  is  uneasy, 
changes  its  position  frequently,  bends  its  body  in  various  direc- 
tions, and  cries  persistently.  Simple  crying,  however  prolonged, 
would  not  be  evidence  of  colic,  but  with  the  contortions  of  the 
body,  and  frequent  change  of  position,  the  diagnosis  is  pretty 
evident.  It  may  continue  but  a  few  minutes,  or  for  half  an  hour. 
When  it  lasts  long  it  is  remittent  or  paroxysmal. 

The  second  form  of  the  disease  presents  the  same  evidences  of 
pain,  but  it  is  of  longer  duration,  continuous,  and  severer.  I 
determine  its  character  principally  from  contraction  of  the  fea- 
tures which  expresses  pain.  The  flexion  of  the  trunk,  and  of  the 
lower  extremities  upon  the  abdomen  is  more  persistent. 

Treatment. — In  many  cases  the  colic  is  speedily  relieved  by 
the  administration  of  Nux  Vomica,  as — I^  Tinct.  Nux  gtt.  ij.. 
water  Siv.;  a  half  teaspoonful  every  fifteen  minutes  or  half  hour. 
If  tlie  child  is  feverish,  Aconite  in  the  usual  doses  may  be  alter- 
nated with  this.  In  other  cases  the  indications  will  be  stronger 
for  Colocynth,  and  I  usually  administer  it  as  follows:  I^  Tinct. 
Colocynth  gtt.  ij.,  Tinct.  Aconite  gtt.  iij.,  water  Siv.;  a  teaspoon- 
ful every  half  hour.  An  infusion  of  Dioscorea,  or  of  Epilobium, 
will  sometimes  give  prompt  relief,  and  sometimes  the  tincture 
will  serve  a  good  purpose. 

If  the  attack  is  very  severe,  and  relief  is  not  obtained  in  this 
way,  an  enema  of  hot  water  (sometimes  cold  is  better),  or  water 
to  which  we  have  added  grs.  xx.  of  Compound  Powder  of  Jalap 
and  Senna  may  be  used. 

Sponging  the  abdomen  with  hot  water,  the  general  hot  bath, 
hot  packs  to  the  abdomen,  a  cold  pack,  if  the  temperature  of  the 
child  is  increased,  a  sinapism,  or  the  application  of  chloroform, 
will  suggest  themselves  to  the  practitioner,  and  will  be  selected 
according  to  the  indications. 

In  some  cases  the  prescription  of  Lobelia  with  Comp.  Tinct. 
I^nvender  may  be  used,  more  rarely  chloroform  may  be  given  by 
mouth.  If  the  pain  is  excessive  chloroform  may  be  used  to 
produce  partial  anaesthesia  and  give  relief.  If  we  can  not  relieve 
the  patient  in  any  other  way  chloral  may  be  given  to  relieve  the 
pain  until  other  means  can  be  employed. 


DIARRHCEA.  319 

If  the  child  suffers  from  gastric  irritation  or  dyspepsia,  we  will 
treat  the  case  as  has  been  named  for  those  affections.  And  if 
owing  to  errors  or  imprudence  in  the  diet  of  the  mother,  we  will 
endeavor  to  have  them  corrected. 

DIARRHCEA. 

Simple  diarrhoea  is  of  very  frequent  occurrence  with  children, 
and  will  arise  from  any  cause  deranging  the  processes  of  digestion, 
or  from  cold.  We  recognize  the  same  forms  of  the  disease  as  in  the 
adult;  first,  from  irritation  of  the  intestinal  canal;  second,  from 
increased  secretion  of  bile;  third,  from  atony  of  the  intestines; 
fourth,  from  congestion  of  the  portal  veins  and  determination 
of  blood ;  fifth,  from  increased  secretion  of  mucus ;  sixth,  from 
imperfect  digestion.  A  simpler  classification,  however,  and  more 
easily  recognized  in  practice,  is  the  two  forms,  diarrhoea  from 
irritation  and  diarrhoea  from  atony. 

Sv^rPTOMS. — In  diarrhcea  from  irritation  the  discharges  from 
the  bowels  are  dark-colored,  usually  a  shade  of  green,  or  in  some 
cases  of  a  light  or  pea-green.  They  are  sometimes  acrid,  so  that 
when  they  have  continued  for  some  time,  they  excoriate  and  chafe 
the  child.  Usually,  the  child  manifests  some  uneasiness  before 
having  a  stool,  and  there  is  some  straining  with  it.  Occasionally, 
there  is  febrile  action,  the  skin  being  harsh  and  the  temperature 
elevated. 

In  diarrhoea  from  atony,  the  discharges  are  light-colored  and 
watery,  and  passed  without  any  pain  or  uneasiness.  They  are 
usually  larger  than  in  the  other  case,  though  the  amount  of  solid 
matter  is  not  increased.  Here,  if  it  persists  for  some  time,  the 
chiUl  seems  relaxed,  the  skin  soft  and  cool,  extremities  cold,  face 
pallid,  and  circulation  enfeebled. 

In  both  cases  the  appetite  is  impaired  if  the  diarrhoea  con- 
tinues, and  what  food  is  taken  is  not  well  digested,  consequently 
the  patient  loses  strength  and  flesh  as  the  disease  progresses. 

Treatment. — The  diarrhoea  of  irritation  may  be  very  fre- 
quently controlled  by  the  use  of  Aconite  alone,  in  the  usual 
doses.  Generally  we  continue  Ipecac  with  it  in  the  following 
projmrtion  :  I^  Tinct.  Aconite  gtt.  iij.,  Tinot.  Ipecac  gtt.  v., 
water  .^iv. ;  a  teaspoonfnl  every  hour.  The  Euphorbia  Hyperi- 
cifolia  will  sometimes  prove  a  better  remedy  than  Ipecac,   and 


320  DISEASES  OF  CHILDREN. 

may  be  substituted  for  it  iu  about  double  the  proportion.  If  the 
patient  compUiius  of  uneasy  sensations  in  the  abdomen,  with 
tormina  and  some  tenesmus,  the  prescription  might  be :  I^ 
Tinct.  Aconite  gtt.  iij.,  Tinct.  Colocynth  gtt.  ij.,  water  5iv. ;  a 
teaspoonful  every  hour. 

In  atonic  diarrhoea  we  frequently  substitute  Nux  for  the  Aco- 
nite, as:  I^  Tinct.  Nux  Vomica  gtt.  iij.,  Tinct.  Ipecac  gtt.  v., 
water  oiv. ;  a  teaspoonful  every  hour. 

AYlien  there  is  evidence  of  irritant  matters  in  the  intestinal 
canal,  an  infusion  of  compound  powder  of  rhubarb  may  be  given 
to  produce  an  action  upon  the  bowels,  and  afterward  in  smaller 
doses  until  the  diarrhoea  ceases.  Or,  after  obtaining  this  action, 
we  may  use  the  subnitrate  of  bismuth,  in  doses  of  one  to  three 
grains,  every  two  or  three  hours. 

In  atonic  diarrhoea,  we  may  use  the  preparation  of  rhubarb, 
above  named,  to  change  the  character  of  the  secretions ;  or  in  its 
place:  ^i  Neutralizing  Cordial  §ij.,  Chloroform  5ss. ;  a  tea- 
spoonful every  hour.  Podophyllin  thoroughly,  triturated  with 
prepared  chalk,  is  an  excellent  remedy  in  these  cases,  when  given 
in  minute  doses,  say  the  1-40  of  a  grain.  If  an  astringent  is 
thought  desirable,  tannic  acid  with  glycerine  will  answer  a  good 
purpose,  and  will  be  readily  taken  by  the  child.  It  may  be  dis- 
solved in  the  uronortion  of  5j.  to  the  ounce,  and  given  in  doses 
of  one-fourth  to  one-half  teaspoonful. 

If  the  tongue  is  pallid,  the  patient  should  have  bicarbonate  of 
soda,  or  in  some  cases  lime  water,  whatever  else  may  be  given.  If 
the  tongue  is  deep-red,  an  acid  should  be  given,  usually  muriatic 
acid.  If  the  tongue  is  red  and  dirty,  the  remedy  will  be  sul- 
phurous acid. 

Leptandrin  is  an  excellent  remedy  in  those  cases  in  which 
there  is  evident  torpor  of  the  liver,  and  would  be  preferable  to 
the  Podophyllin,  were  it  not  that  the  dose  has  to  be  large,  and 
the  remedy  is  very  unpleasant.  Stimulants,  especially  the  aro- 
matics,  may  be  used  in  some  of  these  cases,  but  as  a  general 
rule,  they  are  not  so  beneficial  as  in  the  adult. 

MUCO-ENT^ERITIS. 

Subacute  inflammation  of  the  small  intestine  is  most  usually 
caused  by  cold,  though  it  may  arise  from  irritating  ingostn,  or 
from  decomposition   of  the  food  and  the  production  of  irritant 


MUCO-ENTERITIS.  321 

material  from  this.  The  inflammation  is  confined  mostly  to  the 
mucous  membrane,  the  secretions  of  which  are  increased,  and  an 
increased  peristaltic  action  having  .been  set  up,  there  is  more  or 
less  diarrhoea. 

Symptoms. — The  child  is  restless  and  uneasy,  and  has  consid- 
erable fever.  The  discharges  from  the  bowels  are  not  at  first 
very  frequent,  but  they  are  preceded  by  pain,  the  child  flexing 
the  body  and  the  lower  extremities  to  remove  the  pressure.  The 
discharges  are  attended  with  some  tensemus,  and  in  some  cases 
the  straining  will  be  quite  severe  and  prolonged.  The  stools 
vary  in  character;  in  nursing  children  they  at  first  consist  of 
curded  milk,  mixed  with  a  greenish  feculence,  afterward  they 
contain  mucus,  and  are  slimy  and  tenacious.  In  other  cases  the 
stools  will  be  a  green  or  brownish  frothy  material,  mixed  with 
mucus. 

As  the  disease  progresses  the  discharges  from  the  bowels  be- 
come more  frequent,  and  are  attended  with  greater  uneasiness. 
They  also  contain  more  mucus,  indeed  sometimes  seem  to  consist 
almost  entirely  of  it.  The  febrile  reaction  also  continues,  and 
sometimes  becomes  quite  severe.  Generally  it  will  run  its  course 
in  from  six  to  eight  days,  the  fever  ceases,  the  inflammation  of 
the  bowels  passes  away,  and  the  diarrhoeal  evacuations  stop. 

Diagnosis. — We  diagnose  a  muco-enteritis  by  the  febrile  reac- 
tion which  comes  on  with  the  diarrhoea,  and  by  the  tormina  and 
tensemus  which  attend  the  disch^irges.  From  dysentery  it  is 
distinguished  by  the  feculence  of  the  discharges.  In  some  cases  the 
diseases  are  associated,  and  we  have  a  true  dysenteric  diarrhoea. 

Treatment. — The  treatment  of  this  form  of  diarrhoea  is  very 
simple.  We  put  the  child  upon  the  use  of  Tincture  of  Aconite 
gtt.  ij.  to  gtt.  v.,  Tinct.  Ipecac  gtt.  v.  to  gtt.  x.,  water  S'v. ;  a 
teaspoonful  every  hour.  In  place  of  the  Ipecac  the  Euphorbia 
may  be  used.  If  there  is  much  griping  pain,  we  will  sometimes 
find  Colocyuth,  the  best  remedy,  as — K«  Tinct.  Aconite,  Tinct. 
Colocynth  aa.  gtt.  iij.,  water  ^iv. ;  a  teaspoonful  every  hour. 

In  some  cases  there  will  be  nausea,  not  controlled  with  Aconite 
and  Ipecac  and  in  examining  the  patient  we  will  note  the  ex- 
pressionless mouth,  and  the  pallid  atonic  tongue,  and  Nux  in 
small  doses  will  be  suggested  until  these  symptoms  have  jiassed 
awav.  When  the  tongue  is  broad,  pallid  and  dirty,  the  patient 
21 


322  DISEASES   OF   CHILDREN. 

has  sulphite  of  soda ;  if  deep  red,  an  acid  is  given.  In  some 
cases  the  marked  periodicity  in  the  disease  calls  for  quinine,  and  it 
is  given  in  the  usual  antiperiodic  doses. 

Among  the  older  means  that  may  be  suggested  are  the  white 
liquid  physic,  when  there  is  much  tormina  and  tenesmus;  tritu- 
rated Podophyllin,  or  the  compound  powder  of  rhubarb,  when 
the  discharges  are  light-colored,  and  the  bowels  tumid ;  bismuth, 
either  in  the  form  of  sub-nitrate  or  liquor  bismuth,  or  an  infusion 
of  Epilob.ium.  In  some  cases  where  the  fever  runs  high,  I  have 
given  the  Veratrum  instead  of  Aconite,  and  where  there  was 
much  irritation  of  the  nervous  system,  adding  Gelseminura. 

CfHOLERA   INFANTUM. 

Cholera  infantum  is  a  disease  of  the  second  year  of  childhood — 
a  period  which  may  be  considered  one  of  the  climacterics  of 
life,  as  there  is  now  a  change  from  the  fluid  food  obtained  from 
the  mother,  to  the  ordinary  food  of  man.  The  change  is  a  great 
one,  but  when  there  is  strong  vitality  and  good  development,  it 
is  made  without  any  appearance  of  disease.  But  if  from  any 
cause  the  child  is  enfeebled,  or  its  development  in  other  respects 
is  tardy,  it  then  suffers  in  the  way  we  are  about  to  describe. 

It  is  not  easy  to  say  what  the  exact  pathology  of  this  disease 
is.  '  In  one  case  it  seems  to  be  almost  wholly  an  irritation  of  the 
gastro-intestinal  mucous  membrane;  in  another  it  is  an  atonic 
condition,  and  a  failure  of  power  to  digest  food  ;  in  another  still, 
the  intestinal  lesion  seems  to  be  secondary,  and  depends  upon  a 
want  of  assimilation  and  nutritive  power;  and  in  others  the 
lesion  is  principally  of  the  nervous  system. 

I  conclude  from  all  this,  that  the  lesion  is  primarily  one  of 
the  sympathetic  system  of  nerves  which  govern  all  the  processes 
of  vegetative  life.  In  all  cases  there  is  debility,  though  in  one 
it  may  be  manifested  in  irritative  action,  and  in  the  other  in 
atony. 

Many  have  urged  dentition  as  the  cause,  but  as  this  is  a  phys- 
iological process,  except  when  disturbed,  m'c  would  expect  to  find 
tlie  disease  only  in  cases  of  dental  irritation,  whereas  we  find  it 
in  children  who  hav^e  no  teeth,  Avho  are  not  cutting  teeth  at  the 
time  the  disease  commences,  who  have  all  their  deciduous  teeth 
except  the  four  last  molars,  or  when  showing  no  swelling,  ten- 
derness or  irritation  of  the  gums. 


CHOLERA   IXFAXTUM.  323 

Cholera  infantum  usually  occurs  in  the  summer,  making  its 
appearance  in  May,  June,  or  July,  and  in  the  severer  cases  last- 
ing until  frost  and  cool  nights  in  the  fall.  A  continuous  high 
temperature  always  iucreases  the  severity  of  the  disease,  while 
a  moist  cool  atmosphere  gives  relief.  As  a  general  rule,  it  is 
more  severe  on  low  lauds  than  on  high  ground,  and  is  unfavor- 
ably influenced  by  the  ordinary  malarial  causes. 

Symptoms. — We  may  divide  the  disease  into  two  varieties, 
acute  and  chronie;  the  first  bearing  a  very  close  resemblance  to 
the  cholera  morbus  of  the  adult,  the  second  progressing  slowly 
and  occupying  a  period  of  weeks  or  even  months. 

Acute  cholera  infantum  is  usually  preceded  for  a  day  or  two 
by  a  slight  diarrhoea,  which  gives  the  child  but  little  uneasiness, 
and  is  scarcely  noticed  by  the  mother.  But  presently  the  child 
manifests  an  intense  desire  to  drink  and  greedily  takes  M'hatever 
is  offered.  This  causes  nausea  and  vomiting,  and  the  fluids  are 
thrown  up  about  as  soon  as  taken.  The  diarrhoeal  discharges 
also  become  more  frequent,  and  are  large  and  exhausting. 

In  a  very  short  time  the  child  is  much  prostrated,  there  js  fre- 
quent retching  and  vomiting,  especially  when  any  thing  is  taken 
upon  the  stomach.  The  thirst  is  a  very  marked  feature,  the  child 
wanting  water  all  the  time,  and  crying  for  it  whenever  it  sees  a  cup 
or  glass;  yet  if  even  a  tea-spoonful  is  taken,  it  is  thrown  up. 
The  evacuations  from  the  bowels  have  also  increased  in  fre- 
quency. 

In  some  cases  the  skin  is  harsh  or  dry,  and  the  pulse  hard  and 
increased  in  frequency  ;  in  others  the  skin  is  soft  and  doughy, 
the  extremities  cold,  and  the  pulse  feeble  and  frequent.  Occa- 
sionally the  brain  is  affected,  there  being  congestion  or  a  low 
form  of  determination,  or  eff'usion.  I  recognize  these  cases  by 
the  extreme  restlessness  when  there  is  determination,  and  a  con- 
tinued rolling  of  the  head  from  side  to  side,  and  stupor  in  the 
other  cases. 

The  disease  may  terminate  fatally  during  the  first  twenty-four 
hours,  or  may  continue  for  three  or  four  days — the  child  recov- 
ering— or  gradually  pass  into  the  chronic  form. 

The  chronic  form  of  cholera  infantum  may  follow  the  acute 
attack,  as  above  described.  But  in  a  majority  of  cases  it  is  pre- 
ceded for  a  week  or  two  by  a  simple  diarrhoea,  which,  as  it  does 
not  make  the  child  sick,  is  allowed  to  progress  without  attention. 


324  DISEASES  OF   CHILDREN. 

The  very  gradual  increase  in  the  disease  is  probably  the  reason 
why  an  early  treatment  is  not  adopted. 

The  disease  develops  by  an  increase  of  diarrhoea,  and  the  ap- 
pearance of  nausea  and  vomiting.  The  child  has  lost  flesh  and 
strength,  its  appetite  is  impaired,  and  it  is  thirsty,  wantitig  to 
drink  frequently  and  considerable  quantities.  As  time  passes, 
all  the  symptoms  increase,  but  those  that  are  especially  marked 
are  the  intense  thirst,  irritability  of  the  stomach,  with  frequent 
vomiting,  especially  when  drink  or  food  is  taken,  frequent  evac- 
uations from  the  bowels,  and  great  loss  of  flesh  and  strength. 

The  discharges  from  the  bowels  vary  much  in  character  in 
different  cases,  and  even  in  the  same  case  at  different  times. 
Sometimes  they  are  yellowish,  with  more  or  less  stringy  mucus 
mixed  with  them,  showing  disease  of  the  mucous  follicles ;  at 
others  they  are  greenish,  and  have  a  sour  smell ;  at  others 
clayey ;  again  almost  white,  and  rarely  a  dark  brown  or  blaclc^* 

In  febrile  cholera  infantum  the  skin  is  harsh,  dry  and  con- 
stricted, and  in  some  cases  seeming  to  be  drawn  upon  the  pa- 
tient like  parchment.  There  is  great  irritability  of  the  nervous 
system,  the  patient  being  restless  and  uneasy,  never  satisfied, 
always  changing  its  position,  wanting  everything,  satisfied  with 
nothing,  and  especially  restless  and  wakeful  at  night.  The  child 
seems  to  be  worse  in  the  afterpart  of  the  day  and  evening,  and 
frequently  every  other  day.  When  the  disease  becomes  very 
severe,  it  is  impossible  to  keep  the  child  in  bed  at  night,  the  heat 
seems  to  torture  it,  and  it  is  only  satisfied  when  laid  where  it  can 
turn  freely  about,  or  when  carried  from  place  to  place. 

In  the  non-febrile  form  the  skin  is  soft,  relaxed,  and  flabby,  the 
extremities  cool,  the  bowels  distended  or  pendulous,  the  tongue 
broad,  flabby,  and  coated,  and  the  pulse  small,  soft,  and  fluent. 
The  child  is  not  so  restless  as  in  the  preceding  case,  seems  stupid 
and  dull  when  nursed  in  a  comfortable    position,   but   wants   its 

*Dr  GoldingBird  made  an  anal3'.si.s  of  the  grrrnevncuations  of  cTiUdroi. 
and  found,  contrary  to  wliat  was  generally  supposed,  that  they  gave  no 
indication  of  containing  an  excess  of  bile.  He  conceives  that  their  color 
is  due  to  the  presence  of  altered  blood,  and  that  the  state  in  which  they 
are  produced  is  analogous  to  that  which  exists  in  melaena,  the  portal 
system  being  generally  in  a  congested  state.  In  support  of  his  views,  he 
mentions  that  stools  original!}' of  a  yellow  or  orange  color,  often  turn 
green  on  exposure  to  the  air,  an  occurrence  very  unlike  what  takes  place 
with  matters  containing  bile,  though  it  is  an  ascertained  fact  that  blood, 
under  the  influence  of  several  oxidating  agents,  acquires  a  green  color. 


CHOLERA   INFANTUM.  325 

own  way.  In  both  cases  the  appetite  is  alike  impaired,  there  is 
the  same  nausea,  the  same  desire  for  drink,  and  the  same  pros- 
tration of  strength. 

AVe  sometimes  find  the  brain  affected  in  those  cases  where 
there  is  a  continued  moving  of  the  head  from  side  to  side, 
the  child  sleeping  with  its  eyes  partly  open,  and  rolling  the  eye- 
balls upward.  If  the  pupils  are  somewhat  dilated  and  do  not 
contract  freely,  upon  exposure  to  light,  I  am  satisfied  there  is 
congestion  with  effusion,  and  consider  the  patient's  prospects 
very  poor.  Occasionally  determination  to  the  brain  sets  in,  the 
head  is  hot,  there  is  throbbing  of  the  carotid  arteries,  contrac- 
tion of  the  pupils,  and  great  restlessness  and  uneasiness. 

As  the  disease  lasts  for  weeks,  sometimes  the  whole  summer, 
it  does  not  present  these  active  symptoms  throughout.  There  are 
remissions  and  exacerbations;  for  a  few  days  the  vomiting  will 
cease,  the  appetite  improve,  and  the  diarrhoeal  discharges  are  less 
frequent — consequently  there  is  a  marked  improvement  in  the 
child.  Then,  from  some  slight  indiscretion  in  diet,  or  over-ex- 
ertion, but  more  frequently  from  alternations  of  temperature, 
there  is  another  exacerbation. 

Diagnosis. — The  acute  attack  is  readily  recognized  by  the 
sudden  appearance  of  nausea,  vomiting,  and  diarrhoea,  the  great 
prostration,  and  intense  thirst.  The  chronic  form,  by  its  slow 
accession,  and  the  same  nausea  and  vomiting,  the  intense  thirst, 
the  persistent  diarrhoea,  and  the  impairment  of  digestion  and  nu- 
trition, as  marked  by  the  rapidly  wasting  tissues. 

Prognosis. — The  first  element  of  prognosis  with  me  is  to  de- 
termine the  viability  of  the  child,  and  I  am  guided  in  this  by 
the  depth  of  the  base  of  the  brain,  as  determined  by  the  life  line 
heretofore  described.  If  the  child  has  good  viability,  no  matter 
how  severe  the  disease,  I  am  hopeful,  and  give  a  favorable  prog- 
nosis. But  if  the  life  line  falls  below  half  an  inch  the  pi-ognosis 
is  very  doubtful. 

The  prognosis  is  less  favorable  when  the  brain  becomes  in- 
volved in  the  disease,  presenting  either  irritation  or  congestion. 
Cases,  also,  which  have  been  treated  with  irritant  medicines,  or 
by  the  persistent  use  of  astringents,  are  difficult    to  manage. 

Treatment. — The  treatment  of  the  acute  form  will  be  much 
like  that  for  cholera  morbus  of  the  adult.     The  objects  are   to 


326  DISEASES   OF   CHILDREN. 

t 

arrest  the  voniitiug,  to  check  the  diarrhoea,  aud  to  restore  tone 
to  the  system. 

To  fulfill  the  first  indication  we  have  a  large  list  of  remedies, 
and,  as  is  generally  the  case  where  there  are  so  many  remedies, 
there  are  none  very  certain.  I  think  this  will  apply,  however,  to 
the  medicines  in  ordinary  use,  and  not  to  specifics.  I  will  name 
the  first  in  the  order  in  which  they  are  most  commonly  employed. 
I^  Rhubarb,  Bicarbonate  of  Soda,  Spearmint,  aa.  This,  as  will 
be  recollected,  I  recommend  in  place  of  the  ordinary  neutralizing 
powder  of  the  Dispensatory.  When  the  patient  is  first  seen,  add 
ten  grains  of  the  powder  to  ten  teaspoonfuls  of  cold  water,  and 
allow  it  to  settle ;  give  a  teaspoonful  every  ten  minutes.  Add 
a  teaspoonful  of  the  powder  to  one-third  teacupful  (two  ounces) 
of  boiling  water ;  let  it  stand  until  cool,  strain,  sweeten,  and  if 
the  child  is  somewhat  exhausted,  add  a  teaspoonful  of  brandy. 
As  soon  as  prepared  give  half  teaspoonful  doses  every  half  hour, 
and  as  it  is  retained,  increase  tlie  dose  to  a  teaspoonful  every 
hour,  until  it  acts  slightly  upon  the  bowels. 

The  first  doses  will  be  thrown  up,  but  by  repeating  them  it 
quiets  the  stomach  and  the  nausea  and  vomiting  cease;  if  not, 
after  passing  a  reasonable  length  of  time,  select  another  remedy. 

An  infusion  of  the  bark  of  the  young  twigs  of  the  peach  tree 
is  a  very  reliable  remedy  in  these  cases,  and  may  be  given  in 
small  doses,  frequently  repeated,  until  the  object  is  accomplished. 
The  subnitrate  of  bismuth  in  mint  water,  will  prove  a  good 
remedy  in  some  cases;,  it  is  used  in  the  ordinary  doses. 

In  those  cases  where  there  is  marked  exhaustion,  the  extremi- 
ties being  cold,  stimulants  answer  a  better  purpose  than  other 
remedies.  The  compound  tincture  of  Cajeput  is  a  good  remedy 
in  these  cases.  If  not  convenient,  a  tincture  of  the  essential  oils 
of  cinnamon,  cloves,  peppermint,  etc.,  singly  or  in  combination, 
may  be  employed ;  or  tincture  of  camphor  may  be  used  for  the 
same  purpose.  Chlorodyne,  the  formula  for  which  is  given  in 
the  first  part,  may  sometimes  be  given  with  advantage,  in  doses 
of  about  one  to  two  drops.  Chloroform  may  also  be  used,  and 
will  sometimes  be  tolerated  when  other  remedies  are  not  borne. 

Whatever  is  given,  or  whetlier  anything  is  given,  the  nursing 
is  a  most  important  part  of  the  treatment.  Place  the  child  in 
the  recumbent  ]>osition,  and  wrap  the  feet  in  dry,  hot  flannels, 
keeping  a  plate,  stove-Hd,  or  any  heat-retaining  article  in  con- 
tact with  them,  so  as  to  keep  a  continued  heat.    If  there  is  feeble 


CHOLERA    INFANTUM.  327 

circulation,  and  marked  coldness  of  the  extremities,  the  powdered 
capsicum  or  mustard  may  be  sprinkled  upon  these  flannels.  As 
an  application  over  the  stomach,  I  prefer  the  cold  pack,  either  in 
the  form  of  a  wet  towel  folded,  which  may  be  renewed  as  often 
as  may  seem  necessary,  or  an  entire  abdominal  pack,  which  will 
remain  for  one  or  two  hours,  and  will  then  be  removed,  the  child 
rubbed  thoroughly,  and  wrapped  in  dry  flannel.  The  recumbent 
])osition  should  be  insisted  upon. 

To  quiet  the  thirst,!  prefer  giving  small  pieces  of  ice,  or  tying 
a  piece  in  a  cloth  for  the  child  to  suck.  If  ice  can  not  be  had, 
then  give  cold  water,  a  teaspoonful  at  a  time,  every  few  minutes. 
Sometimes  a  very  little  salt  added  to  the  water  causes  it  to  be 
retained  better.  When  the  vomiting  is  persistent,  and  the  thirst 
excessive,  I  have  employed  an  injection  of  salt  water  with  good 
advantage.  It  is  used  in  considerable  quantity,  and  may  be 
repeated  when  it  passes  away. 

We  have  now  to  speak  of  specific  remedies  for  this  disease,  and 
though  they  are  not  cure-alls,  they  deserve  attention.  When  the 
skin  is  hot  and  dry,  the  pulse  hard,  and  other  evidences  of  a 
febrile  condition.  Aconite  is  the  remedy.  I  use  it  in  the  ordinary 
proportion  of  two  drops  to  water  four  ounces,  but  give  one- 
fourth  of  a  teaspoonful  every  fifteen  minutes.  The  directions 
above  as  to  nursing,  must  be  implicitly  followed. 

In  an  ordinary  case,  I  order  Aconite  and  Ipecac  alternately; 
they  are  prepared  for  use  by  adding  two  drops  of  Aconite  and  five 
drops  of  Ipecac  to  four  ounces  of  water,  and  give  a  teaspoonful 
every  hour.  They  may  be  a  little  slow  but  are  very  certain  in 
their  action. 

When  the  face  is  pallid,  and  the  mouth  expressionless,  the 
tongue  pallid  and  atonic,  Nux  will  serve  our  purpose  best.  It  is 
given  in  quite  small  doses,  gtt.  j.  to  gtt.  ij.  to  water  5iv.;  a  tea- 
spoonful every  fifteen  minutes  until  the  nausea  is  quieted.  The 
Ipecac  is  added  in  the  usual  proportion,  and  the  two  are  continued 
until  the  diarrhoea  stops.  It  is  a  little  singular,  but  there  is 
in  the  market  much  so-called  "  fluid  extract"  of  Nux  Vomica, 
that  has  no  bitterness,  and  of  course  is  absolutely  worthless. 
Such  stufl^  is  not  recommended. 

In  the  acute  form  of  the  disease  we  have  accomplished  the 
greater  part  of  the  cure,  when  we  have  arrested  the  nausea  and 
vomiting,  and  generally  any  simple  remedy  adapted  to  the  case. 


328  DISEASES   OF    CHILDREN. 

will  be  sufficient  to  arrest  the  diarrhoea.  In  my  practice  I  depend 
almost  wiiolly  upon  the  continued  use  of  Aconite  and  Ipecac. 

In  true  cholera  infantum  (chronic)  it  is  well  to  make  the  clas- 
sification of  cases — irritative  and  atonic.  Sometimes  this  is  very 
readily  done,  as  the  symptoms  are  so  marked,  but  in  others  we 
reach  a  half-way  ground,  a  debatable  land,  and  the  classification 
can  not  be  made. 

In  some  cases  the  irritation  of  the  stomach  is  extreme,  so  that 
the  child  can  take  neither  food  nor  medicine  with  advantage. 
Aconite  and  Ipecac  in  very  small  doses,  with  restrictions  in  drink, 
(thirst  is  extreme,)  will  frequently  relieve  the  stomach.  Some- 
times Euphorbia  is  substituted  for  the  Ipecac,  or  if  there  is  much 
tormina  and  straining  at  stool,  Colocynth  may  be  used.  The  dose 
of  course  must  be  very  small.  ]^  Tinct.  Aconite,  Tinct.  Colo- 
cynth, aa.  gtt.  ij.  water  .5iv.;  a  teaspoonful  every  hour.  (The 
medicine  should  be  kept  cool,  and  prepared  fresh  every  day.) 

If  the  tongue  is  pallid,  the  face  expressionless,  and  sallow  or 
yellow  about  the  mouth,  Nux  Vomica  will  be  the  remedy  to  re- 
lieve the  nausea.  One  or  two  drops  may  be  added  to  a  half  glass 
of  water,  and  given  in  doses  of  one  teaspoonful  every  half  hour  or 
hour.  Ipecac  may  be  added  in  some  cases  to  assist  in  relieving 
the  nausea,  or  after  a  day  or  two  to  control  the  diarrhoea. 

The  Compound  Powder  of  Rhubarb,  infusion  of  Peach  bark, 
Bismuth,  Hydrate  of  Chloral,  and  sometimes,  but  rarely,  stimu- 
lants may  be  employed,  as  heretofore  named. 

In  some  cases  we  find  marked  irritation  of  the  brain,  and  indi- 
cations forGelseminum.  In  others  the  patient  is  dull  and  stupid 
and  Belladonna  is  wanted.  There  are  cases  in  which  the  child  is 
extremely  restless,  starts  in  his  sleep,  awakes  frightened,  cries  out 
shrilly,  and  at  the  same  time  has  a  peculiar  pinched  expression 
about  the  eyes  and  base  of  the  brain.  The  symptoms  are  char- 
acteristic, and  the  remedy  is  Rhus,  and  when  thus  indicated  it 
will  quiet  irritation  of  the  stomach,  and  check  the  diarrhoea. 

There  are  cases  in  which  sulphurous  acid  becomes  an  excellent 
remedy;  cases  that  require  sulphite  of  soda ;  cases  that  want  a 
simple  alkali,  bicarbonate  of  soda  or  lime  water;  and  others  that 
want  muriatic  acid.  Here,  as  elsewhere,  the  indications  for  rem- 
edies should  be  followed. 

Podoj)hyllin  thoroughly  triturated  with  sugar  of  milk  or  loaf 
sugar,  in  minute  doses,  is  sometimes  an  excellent  remedy.  Its 
use  is  in  those  cases  in  which  there  is  atony  of  the  stomach,  and 


CHOLERA   INFANTUM.  329 

congestion  of  the  liver  and  portal  circle.  Cases  in  which  the 
tongue  is  broad,  and  coated,  the  abdomen  swollen,  the  skin  sallow, 
and  the  temperature  lowered.  Leptandrin  is  used  in  these  cases, 
but  is  not  so  easily  taken  by  children,  and  owing  to  its  nauseous 
taste,  is  not  so  well  tolerated  by  tiie  stomach. 

In  cases  where  there  is  any  evidence  of  periodicity,  usually 
manifested  by  increase  of  nausea  and  vomiting  and  diarrahoea, 
quinia  may  be  employed  with  advantage.  I  prescribe  it  as  I  do 
in  intermittents,  every  two  hours,  until  three  doses  are  taken,  or 
one  dose  of  two  grains,  at  the  time  when  the  patient  is  most  free 
from  nausea.  In  some  cases  its  action  is  very  decided — it  checks 
the  nausea  and  vomiting,  lessens  the  thirst,  allays  the  irritation 
of  the  nervous  system,  and  indeed,  seems  to  improve  every  func- 
tion ;  and  repeated  for  a  few  days,  the  patient  is  convalescent.  In 
some  cases  minute  doses  of  Arsenic  with  Veratrum  will  quiet  the 
gastro-intestinal  irritation,  and  strengthen  digestion  better  than 
anything  else. 

When  there  is  a  soft  compressible  pulse,  a  relaxed  and  pale 
skin,  and  cold  extremities,  I  have  used  the  quinine  inunction 
with  benefit.  I  think  in  some  very  bad  cases,  it  has  given  tone 
to  the  system,  and  so  added  to  the  patient's  power  to  live,  as  to 
tide  over  the  summer  to  frost,  and  convalescence. 

Fatty  inunction  alone,  answers  a  very  good  purpose.  When 
the  skin  is  dry  and  harsh,  it  is  the  best  means  to  soften  it  and 
place  it  in  condition  for  secretion.  When  it  is  soft  and  relaxed, 
by  adding  a  stimulant  to  it,  and  using  it  with  friction,  it  is  a 
good  means  to  stimulate  capillary  circulation.  I  do  not  like  the 
free  bathing  sometimes  recommended,  as  there  is  not  the  power 
of  re-action,  without  which  the  use  of  water  must  do  harm.  If 
the  child  is  bathed,  let  it  be  thoroughly  and  quickly  washed  with 
soap  and  water,  or  with  salt  and  water,  if  the  inunction  is  not 
practiced. 

In  some  cases  of  cholera  infantum  a  soft  flannel  bandage  is 
applied  to  the  abdomen,  and  gives  as  ranch  relief  as  the  medicine. 
A  bag,  a  foot  square,  filled  with  good  Fenugreek  seed,  sprinkled 
with  oil  of  cloves,  or  some  other  of  the  essential  oils,  and  quilted 
a  half  inch  thick,  and  worn  over  the  stomach,  will  give  marked 
relief  in  some  cases.  It  is  after  the  order  of  the  old  fashioned 
spice  plaster,  but  is  better. 

Much  will  depend  upon  the  diet  of  the  child  in  some  cases. 
As  a  general  rule,  the  mother's  milk  is  preferable,  and  the  case 


330  DISEASES  OF   CHILDREN. 

would  be  exceptional  where  I  would  recommend  that  it  be 
weaned;  still  there  are  such  cases.  When  the  child  has  been 
weaned,  however,  we  will  have  to  take  this  into  consideration. 
The  directions  heretofore  given  will  enable  us  to  determine 
whether  the  milk  in  use  is  good.  If  we  see  reason  to  change 
this,  Liebig's  food  will  be  found  the  best,  where  it  can  be  taken. 

Raw  or  rare  cooked  beef  will  sometimes  agree  well  v'ith  a 
child  when  it  has  been  unable  to  take  other  food.  Pickled  pork 
will  sometimes  answer  well,  and  be  digested  when  the  stomach 
will  not  tolerate  lighter  articles  of  food.  The  child's  appetite  may 
be  gratified,  and  indeed  it  may  be  taken  as  a  guide,  with  refer- 
ence to  all  such  things  as  constitute  the  healthy  food  of  the 
country,  only  excepting  some  vegetables  and  fruits.  In  regard 
to  the  latter,  we  have  difficulty  sometimes  in  determining  whether 
any,  or  what  may  be  given  with  safety.  As  a  general  rule,  ripe 
peaches  and  blackberries,  fresh  from  the  vines,  will  be  the  only 
ones  we  can  give  with  safety. 

The  excessive  thirst  is  an  annoying  feature  of  the  disease,  and 
we  will  be  anxiously  asked  about  gratifying  it  every  time  we  see 
the  patient.  In  some  cases  the  child  may  have  all  the  water  it 
wants,  even  though  it  causes  vomiting  at  first,  for  by  giving 
drink  freely  in  this  way  the  irritation  of  the  stomach  is  overcome. 
These  cases,  I  am  sorry  to  say,  are  few.  The  rule  of  practice  is. 
that  the  child  must  be  restricted  to  small  quantities  of  water 
until  the  disease  is  arrested  ;  it  may  be  given  frequently,  however, 
and  this  is  some  alleviation  of  the  thirst.  In  other  cases,  when 
the  stomach  refuses  to  tolerate  water  we  order  ice,  and  it  may  be 
given  quite  freely  without  danger,  and  sometimes  with  benefit. 
Recollect  the  injection  of  salt  water  in  these  cases,  and  the  ad- 
vantage that  sometimes  follows  from  the  use  9f  the  wet- pack. 

Convalescence  must  be  managed  with  care,  and  indiscretions 
in  diet  avoided.  I  frequently  put  the  little  patient  on  the  use  of 
tincture  of  muriate  of  iron  and  glycerine,  as  heretofore  named, 
and  sometimes  associate  it  with  phosphate  of  soda,  three  grains, 
three  times  a  day. 

TABES  MESENTERICA. 

Tuberculous  disease  of  the  intestinal  canal  is  most  usually 
met  with  in  childhood,  though  occasional  cases  will  be  seen  even 
up  to  the  age  of  twenty-five.     It  occurs  only  in  those  constitu- 


TABES   MESENTERICA.  331 

tions  which  we  have  before  referred  to  as  being  tuberculous,  and 
where,  if  the  irritation  had  been  of  the  lungs  instead  of  the 
bowels,  it  would  have  been  phthisis. 

The  pathology  of  the  disease  is  well  described  by  Habershon  : 
"  In  disease  of  the  mesenteric  glands,  a  low  organized  product  is 
effused  into  the  glands  themselves,  probably  because  the  chyli- 
ferous  ducts  become  entirely  obliterated,  and  the  structure  of  the 
gland  destroyed.  Their  extensive  disease  prevents  the  absorption 
of  chyle  into  the  system.  The  glands  share  the  disease  in  vari- 
ous stages  and  gradations  ;  in  some,  but  scanty  abnormal  product 
is  found,  in  others  the  whole  gland  is  destroyed  and  very  much 
enlarged,  constituting  a  whitish  mass,  the  size  of  a  pigeon's  or 
hen's  egg.  The  effused  product  consists  of  granular  blastema, 
and  imperfectly  developed  cells.  The  swollen  and  injected  state 
of  the  glands  less  affected,  appears  to  indicate  that  inflammation 
or  hypersemia  is  associated  with  the  disease.  The  increase  takes 
place  by  additions  to  the  periphery  of  that  already  deposited,  and 
degeneration  occurs  in  the  center  from  the  scanty  supply  of 
nourishment  afforded  to  the  central  part.  The  gland  sometimes 
appears  to  be  enveloped  by  a  firm,  fibrinous  cyst,  which  consists 
of  inflammatory  product  better  organized,  having  assumed  the 
character  of  fibrous  tissue,  while  the  center  consists  of  calcareous 
deposit,  the  albuminous  portion  having  been  absorbed,  and  the 
organic  only  left.  Degeneration  of  another  character,  however, 
takes  place  in  the  effused  product,  it  is  converted  into  a  mass  of 
granular  molecules  and  highly  refracting  particles,  constituting 
small,  cheesy  tubercles  of  a  yellow  color,  or  a  softened  and  semi- 
diffluent  mass.  The  lacteals  between  the  glands  become  enlarged 
and  distended  with  similar  strumous  product,  or  we  can  trace  the 
distended  ducts  to  the  intestine,  where  they  ramify  on  its  surface, 
and  at  this  part  we  generally  find  a  cluster  of  tubercles  and 
ulceration  of  the  raucous  membrane." 

Symptoms. — In  children  it  is  usually  preceded  by  diarrhoea 
and  gradually  increasing  prostration.  The  appetite  is  usually 
good,  sometimes  ravenous,  but  the  patient  receives  no  apparent 
benefit.  The  bowels  are  sometimes  tumid,  hot  and  tender,  at 
others  very  much  shrunken  ;  the  evacuations  consisting  of  a  thin 
mucus,  greenish,  and  frequently  i-esembling  the  washings  of  meat. 
The  countenance  is  contracted  and  ])inched,  the  eyes  set  far  back 
in  the  head,  and  the  skin  peculiarly  dry,  wrinkled,  and  sallow, 


332  DISEASES  OF    CHILDREN. 

giving  the  child  a  prematurely  aged  appearance.  It  is  restless, 
irritable  and  fretful,  and  presents  many  of  the  symptoms  of 
cholera  infantum. 

In  the  adult  there  may  or  may  not  be  diarrhoea,  frequently  an 
alternation  of  diarrhoea  and  constipation,  and  sometimes  severe 
pain.  There  is  a  marked  marasmus,  increasing  day  by  day, 
though  tiie  appetite  may  be  good,  and  the  digestion  seemingly 
well  performed.  The  patient  has  an  anxious  expression  of  coun- 
tenance, a  sallow,  wrinkled  skin,  contracted  abdomen,  and  is 
uneasy,  restless  and  irritable.  In  the  latter  stage  diarrhoea  some- 
times sets- in,  and  carries  the  patient  oiF  quickly,  or  disease  of  the 
brain  or  lungs  comes  on  to  assist  the  tabes.  In  both  cases  the 
enlarged  mesenteric  glands  can  frequently  be  felt  through  the 
abdominal  wall. 

Diagnosis. — Tabes  mesenterica  is  diagnosed  with  difficulty. 
The  principal  symptoms  leading  us  to  believe  in  strumous  dis- 
ease of  the  mesentery  are:  the  continuance  of  a  good  appetite, 
and  seemingly  good  digestion,  with  continually  increasing  loss  of 
strength  and  flesh,  and  the  evidence  of  disordered  bowels,  and 
in  the  latter  stages  feeling  the  enlarged  mesenteric  glands  through 
the  abdominal  walls.  It  will  be  seen  that  our  diagnosis  will 
have  to  be  made  principally  by  exclusion,  a  very  common  method, 
and  possibly  more  correct  than  by  direct  symptoms. 

Prognosis. — The  prognosis  in  well  marked  cases  of  this  dis- 
ease is  exceedingly  unfavorable,  as  much  so  as  any  disease  we  are 
called  to  treat.  In  the  earlier  stages  its  progress  may  be  arrested 
as  it  may  also  occasionally  in  the  latter. 

Treatment. — A  tonic  and  restorative  treatment  would  seem 
to  offer  the  best  results  in  these  cases.  Yet  we  find  that  it  does 
not  prove  so  serviceable  as  some  other  means.  The  general 
inunction  with  quinine  once  a  day,  and  the  use  of  the  Uvedalia 
ointment  to  the  abdomen  is  recommended.  In  some  cases  small 
doses  of  Arsenic  exert  a  beneficial  influence  as  :  I^  Fowler's 
Solution  gtt.  X.,  Tinct.  Veratrum  gtt.  v.,  water  5iv. ;  a  teaspoon- 
fnl  every  tiiroe  or  four  hours.  Hypophosphite  of  lime  is  a  good 
remedy,  as  is  the  compound  syrup  of  the  hypophosphites  ;  cod-liver 
oil  has  given  very  good  results  when  it  could  l)e  taken  well  and 
digested.  In  some  (!ascs  a  good  projinrntiou  of  malt,  taken  after 
the  foods,  aids  in  digestion,  and  the  child  will  improve  on  it. 


DYSENTERY.  •  333 

Small  doses  of  Ipecacuanha,  alternated  with  Aconite,  may  be 
employed  to  relieve  the  irritation  of  the  bowels,  and  check  diar- 
rhoea when  it  is  present.  Or,  in  place  of  these,  we  may  use  the 
extract  of  Hamamelis  (Pond's),  which  I  think  very  highly  of. 
The  dose  will  be  about  ten  drops  four  times  a  day. 

The  use  of  Alnus,  Rumex,  Scrofularia,  and  others  of  our  vege- 
table alteratives,  has  been  recommended;  but  I  think  they  will 
not  prove  so  serviceable  as  the  means  above  named. 

DYSENTERY. 

Inflammation  of  the  large  intestine  in  the  child  arises  from 
the  same  causes,  and  presents  somewhat  similar  symptoms  to  the 
same  disease  of  the  adult.  It  occurs  in  both  the  sporadic  and 
epidemic  form,  though  in  some  epidemics  children  are  remarkably 
exempt  from  it.  Indeed,  as  a  general  rule,  we  will  find  that  dys- 
entery in  the  child  is  rarely  the  active  inflammatory  affection 
that  we  are  called  to  treat  in  the  adult. 

Causes. — The  common  cause  of  sporadic  dysentery  is  cold, 
though  it  may  be  produced  by  indigestible  food,  or  such  derange- 
ment of  the  digestive  process  as  will  permit  the  decomposition 
of  food  and  formation  of  irritant  products.  Epidemic  dysentery 
depends  upon  the  influence  of  an  animal  poison;  what  it  is  we 
do  not  know,  nor  why  it  acts  upon  this  particular  portion  of  the 
body. 

Pathology. — Dysentery  is  a  true  inflammation  of  some  por- 
tion of  the  large  intestine — a  colitis.  The  inflammation  may 
involve  but  a  small  portion  of  the  intestine,  and  be  confined  to 
the  mucous  membrane,  or  it  may  involve  the  greater  part  or  all, 
and  extend  to  the  muscular  and  peritoneal  coats.  There  are 
some  cases  in  children  in  which  the  inflammatory  character  is 
not  marked,  but  rather  an  irritation  of  the  mucous  coat,  with 
increased  secretion,  and  of  the  muscular  coat,  with  increased 
peristaltic  movement.  This  form  of  the  disease  is  not  attended 
by  fever,  and  may  continue  for  weeks  or  months  without  danger 
to  life. 

Symptoms. — In  acute  sporadic  dysentery  of  the  child,  it  is 
first  noticed  that  the  bowels  are  moving  loo  frequently,  and  there 
is  considerable  straining  at  stool.     The  discharges,  however,  are 


334  •  DISEASES   OF  CHILDREN. 

feculant,  though  small,  but  if  noticed  closely  they  will  look 
slimy,  and  after  a  day  has  passed  they  will  be  almost  pure  mucus, 
or  mucus  tinged  with  blood. 

As  the  dysenteric  character  of  the  discharges  becomes  marked, 
febrile  symptoms  appear.  The  child  is  restless  and  uneasy,  the 
skin  is  dry,  the  pulse  is  accelerated  and  hard,  the  appetite  im- 
paired, and  indeed  all  the  functions  of  the  body  deranged.  These 
symptoms  vary  greatly  in  different  cases — in  some  the  fever  runs 
high,  in  others  it  is  hardly  noticed. 

But  as  the  disease  progresses  the  discharges  become  more  fre- 
quent, every  fifteen,  ten,  or  even  every  five  minutes;  they  are 
preceded  by  pain,  and  attended  with  tenesmus.  This  straining 
at  stool  is  so  marked  a  feature  with  the  child,  and  so  strongly 
expressed  in  its  countenance,  that  it  is  an  index  to  the  character 
of  the  disease  as  soon  as  seen.  Day  by  day  the  child  loses 
strength,  and  the  general  and  local  disease  seems  to  gain  inten- 
sity, until  the  fifth  or  sixth  day;  then  there  is  a  gradual  amend- 
ment, until  convalescence  is  completely  established.  I  speak 
of  this  as  being  the  usual  course  of  the  disease  when  not  influ- 
enced by  medicine. 

Epidemic  dysentery  presents  the  same  symptoms  that  it  does 
in  the  adult.  Commencing  with  evidences  of  prostration,  and 
impairment  of  the  general  health,  there  is  usually  a  well  marked 
chill,  which  is  followed  by  febrile  reaction.  This  general  dis- 
ease assumes  so  prominent  a  place  at  first,  that  it  overshadows 
the  local  inflammation.  Yet,  at  first,  there  is  an  irritation  and 
increased  activity  of  the  bowels,  and  with  the  development  of 
the  fever,  the  small  mucous  or  bloody  dysenteric  evacuations  be- 
come marked. 

It  is  not  worth  while  in  this  place  to  enter  into  a  lengthy  de- 
scription of  the  symptoms  presented,  as  they  are  a  continuation 
of  those  above  described,  with  a  remittent  or  continued  fever. 
As  the  disease  progresses,  it  develops  typhoid  symptoms,  both 
general  and  local,  and  in  the  severer  cases  it  becomes  a  very 
grave  affection. 

The  dysenteric  irritation  referred  to  when  speaking  of  the 
causes  of  this  disease,  presents  but  a  part  of  the  symptoms  of 
dysentery.  The  discharges  are  attended  with  straining,  are 
small,  and  in  some  are  wholly  mucus,  in  others  mucus  mixed 
Avith  foculant  matter.  They  are  also  frequent,  and  in  some  cases 
it  seems  that  the  child  can  not  stoop  or  be  placed  in  a  constrained 


en 


DYSENTERY.  335 

position  without  an  action  of  the  bowels.  But  the  general  health 
is  less  affected  than  we  would  suppose,  not  nearly  so  much  in 
most  cases  as  in  ordinary  diarrhoea.  Still,  as  it  continues  for  a 
longtime,  it  is  a  cause  of  much  annoyance  to  both  parents  and 
physician. 

Diagnosis. — The  diagnosis  of  dysentery  is  made  with  ease. 
No  one  could  see  the  peculiar  expression  of  countenance  during 
the  tenesmus,  Avithout  at  once  recognizing  what  was  the  matter, 
even  if  he  had  never  seen  a  case  of  the  disease. 

Prognosis. — The  prognosis  is  favorable  in  the  sporadic  dys- 
v,.itery  of  children,  but  in  those  epidemics  that  reach  children 
the  mortality  is  greater  than  in  the  adult. 

Treatment. — In  the  mild  sporadic  form  of  the  disease,  my 
practice  resolves  itself  into  the  administration  of  Aconite  with 
Ipecac  in  the  usual  doses.  The  general  bath  is  used,^  and  the 
hot  foot-bath,  and  the  child  is  kept  still,  and  in  some  cases  a 
cloth  spread  with  lard  or  mutton  suet  is  applied  over  the  abdo- 
men. Tiie  treatment  is  very  simple  and  very  satisfactory,  and 
I  should  be  glad  if  all  treatment  were  as  much  so. 

When  there  is  persistent  abdominal  pain  or  tormina,  I  like 
the  action  of  Colocynth,  in  the  small  doses  heretofore  named. 
In  some  cases  Veratrum  may  be  used,  and  if  there  is  evidence 
of  determination  of  blood  Gelseminum  is  given  with  it. 

In  some  cases  the  broad  pallid  and  dirty  tongue  calls  for  sul- 
phite of  soda,  and  it  is  given  in  doses  of  from  two  to  five  grains 
every  three  hours  until  the  tongue  has  cleaned.  Sulphurous 
acid  is  an  excellent  remedy  in  typhoid  dysentery,  the  tongue 
being  red  and  full,  and  covered  with  a  nasty  glutinous  coat. 

In  the  olden  time,  the  white  liquid  physic  of  our  Dispensatory, 
held  a  prominent  place  in  the  treatment  of  dysentery.  And  it 
may  yet  be  used  with  advantage  in  some  seasons.  I  advise  that 
the  proportion  of  acids  be  diminished  as  follows:  ^i  Sulphate 
of  soda  oviij.,  water  Sxxiv.,  Nitric  acid,  Muriatic  acid,  aa.  5ss. 
Mix.  Tlie  dose  for  a  child  two  or  three  years  old  will  be  a 
teaspoonfnl  every  two  hours,  (with  syrup),  until  it  moves  the 
bowels  gently,  then  in  smaller  doses.  In  some  cases  olive  oil 
may  be  used  to  move  the  upper  intestine. 

If  in  ;i  malarial  region,  we  look  carefully  for  periodicity,  Avhich 
will  be  found  iti   many  cases.     Hero  quinine  is  an  indispensable 


336  DISEASES   OF   CHILDREN. 

remedy,  the  patient  being  prepared  for  it,  and  it  is  given  in  the 
usual  doses. 

In  some  cases  Ipecacuanha  may  be  prescribed  alone,  triturated 
with  powdered  gum  arabic,  which  is  a  good  form,  or  combined 
with. bismuth,  as:  I^  Subnitrate  of  Bismuth,  3ss.;  Ipecac  gr.  iv.; 
mix  and  divide  in  eight  powders,  giving  one  every  one  or  two 
hours. 

The  same  treatment  is  employed  for  the  local  lesion  in  the 
epidemic  form  of  the  disease,  and  in  addition  such  remedies  as 
will  antagonize  the  septic  tendency,  and  give  tone  and  support 
to  the  system.  These  have  been  fully  described  under  tlie  head 
of  continued  fever,  to  which  the  reader  is  referred.  In  some  of 
these  cases  the  Ipecacuanha  seems  to  fulfill  nearly  all  the  indica- 
tions, and  it  is  given  with  the  best  results.  In  others  the  use  of 
white  liquid  physic  to  the  extent  of  gentle  purgation,  afterward 
in  smaller  doses,  answers  best;  and  in  still  others  we  obtain  the 
best  results  from  bismuth. 

In  dysenteric  irritation  we  find  a  very  stubborn  case,  and  one 
that  sometimes  refuses  to  yield  to  remedies,  literally  wearing 
out.  I  place  most  dependence  upon  the  continued  use  of 
minute  doses  of  Aconite,  for  several  days ;  next  upon  the  use 
of*  the  subnitrate  of  bismuth.  Occasionally  we  find  a  case  in 
which  there  is  evident  relaxation  of  the  rectum,  with  congestion, 
and  in  such  the  fluid  extract  of  Hamamelis  will  prove  very  good. 

The  local  means  will  consist  of  cold  packs  to  the  abdomen, 
the  disease  being  sthenic  and  the  patient  carrying  a  high  temper- 
ature ;  or  hot  packs,  or  sponging  the  abdomen,  if  the  disease  is 
of  a  lower  grade.  In  some  cases  a  hot  sitz  bath  gives  relief, 
and  the  patient  has  rest  and  sleep  for  a  few  hours. 

In  some  cases  we  are  obliged  to  use  enemata  to  get  rest  for 
the  inflamed  bowels,  and  exhausted  patient.  Sometimes  water 
as  warm  as  it  can  be  borne  serves  a  good  purpose,  but  usually  we 
think  of  tinct.  Opium  gtt.  v.  to  x.,  starch  water  5ij-  to  5ss. — this 
is  repeated  after  each  evacuation. 

CONSTIPATION. 

Constipation  is  an  attendant  on  mntiy  acute  diseases,  and  is 
generally  to  be  regarded  as  a  favorable  indication,  though  we 
may  have  to  use  means  to  overcome  it.  It  is  also  met  wi'th  as  an 
idiopathic  affection,  and  it  is  this  form  that  we  wish  to  consider. 


CONSTIPATION.  337 

Infantile  constipation  seems,  in  a  majority  of  cases,  to  be  aeon- 
genital  defect  in  the  irritability  of  the  intestinal  canal,  rather  than 
an  acqnired  lesion.  Thus  we  will  find  it  manifested  early,  the 
child's  bowels  not  moving  for  two  or  three  days  after  birth,  and 
continued  on  until  by  change  of  food,  during  the  second  year, 
a  normal  activity  is  induced.  In  some  cases  it  seems  to  be  de- 
pendent upon  constipation  of  the  mother,  the  acquired  vice 
in  her  constitution  manifesting  itself  in  the  condition  of  the 
child.  In  some  others  it  is  dependent  upon  the  character  of 
her  food ;  but  in  the  majority,  we  can  give  no  reason  for  it,  and 
we  have  simply  the  fact  that  constipation  exists. 

Sometimes  the  constipation  is  attended  with  uneasiness  in 
the  abdomen  and  colic;  but  in  the  majority  of  cases  the  child 
^oes  not  suffer  at  all,  but  nurses  well,  and  thrives  like  other 
children,  and  were  our  attention  not  called  to  it  by  the  mother, 
we  would  not  suspect  anything  wrong.  In  some  cases  the  child 
will  make  forcible  efforts  to  stool,  and  may  pass  a  small  portion 
of  hardened  feces,  at  such  times,  or  nothing  may  pass.  Such  at- 
tacks of  tenesmus  may  come  on  three  or  four  times  a  day,  and 
are  very  unpleasant.  Indeed,  this  is  the  only  case  that  demands 
special  attention. 

Trkatment. — If  the  mother  is  of  a  constipated  habit,  we  will 
be  more  successful  in  removing  the  torpor  of  the  child,  by  such 
means  as  will  restore  normal  activity  to  her,  rather  than  by 
giving  it  medicine.  The  means  I  commonly  employ  are — that 
on  first  rising  in  the  morning,  a  glass  of  cold  water  be  taken, 
adding  to  it  one  or  two  drops  of  tincture  Nux  Vomica ;  that  the 
abdomen  be  thoroughly  rubbed  with  the  hand  dipped  in  salt 
water;  and  that  a  regular  time  be  set  apart  (immediately  after 
breakfast  is  best)  to  evacuate  the  bowels.  Should  this  not  be 
sufficient,  ten  or  twenty  grain.^  of  phosphate  of  soda  may  be 
taken  in  a  glass  of  water,  on  going  to  bed. 

As  remarked  above,  the  medication  of  children  to  overcome 
constipation  is  not  very  successful,  sometimes  we  will  accomj)lish 
the  object,  at  others  we  will  be  partially  successful,  and  in  others 
we  will  fail  entirely.  Phosphate  of  soda,  in  doses  of  two  or 
three  grains,  three  times  a  day,  will  occasionally  answer  the  pur- 
pose, and  the  influence  is  usually  permanent.  Small  doses  of 
Belladonna  may   also  be  given,   with    the  expectation  of  good 

results,  in  some  cases.     In  those  cases  where  the  abdomen  is  re- 
22 


338  DISEASES  OP   CHILDREN. 

laxed  and  pendulous,  with  a  torpid  circulation,  small  doses  of 
Nux  Vomica  will  answer  the  purpose ;  and  where  the  liver  is 
inactive,  Leptandrin,  thoroughly  triturated,  may  be  given  in 
doses  of  one-fourth  to  one-half  grain. 

When  the  child  suffers  from  tenesmus,  it  is  well  to  move  the 
bowels  at  first  with  olive  oil  or  castor  oil,  and  then  follow  with 
the  means  named  above. 

Dr.  Tanner  remarks,  that  "  since  reading  Corvisart's  views  on 
the  action  of  pepsin,  he  has  extensively  used  the  remedy ;  which 
may  be  given  to  the  youngest  infant,  in  doses  of  three  to  six 
grains,  dissolved  in  milk,  twice  daily.  It  seems  to  relieve  con- 
stipation in  the  same  way  that  it  checks  some  forms  of  diarrhoea, 
by  enabling  the  stomach  to  do  its  work  thoroughly."  If  we  use 
pepsin  for  this  purpose,  it  will  be  quite  as  well  to  use  ordinary 
rennet,  giving  the  water  in  which  it  is  soaked  in  quantities  of  one 
or  two  teaspoonfuls,  each  time  after  nursing. 

I  think  the  use  of  enemas  and  suppositories,  in  these  cases, 
should  be  abandoned,  as  they  are  likely  to  do  more  injury  to  the 
rectum,  than  they  do  good  in  relieving  the  constipation.  I  have 
omitted  to  mention  one  thing  which  I  regard  as  important  in 
some  of  these  cases,  to  see  that  the  child's  clothing  is  worn  loose. 
Not  unfrequently  the  band  is  put  on  so  tightly  as  to  paralyze  the 
abdominal  muscles,  and  I  have  no  doubt  that  this  is  the  principal 
cause  in  some  cases.  Thoroughly  rubbing  the  abdomen  with  the 
hand,  and  a  little  lard,  will  prove  beneficial  in  these  cases. 

PROLAPSUS   ANI. 

Prolapsus  ani  is  met  with  most  frequently  from  the  age  of  two 
to  four  years,  though  it  is  sometimes  seen  during  the  first  months 
of  life.  It  comes  on  slowly,  but  as  it  is  not  noticed  in  its  early 
stages,  it  seems  to  the  mother  as  if  it  had  wholly  developed  within 
a  few  hours. 

In  almost  all  cases  there  is  a  softness  and  relaxation  of  the 
perineal  tissues,  which  will  be  noticed  as  soon  as  the  child  is  ex- 
amined. In  some  the  sphincter  ani  seems  mostly  at  fault,  having 
so  lost  its  power  of  contraction  that  it  is  not  able  to  support  the 
bowel.  We  may  recognize  two  varieties  of  the  disease:  In  the 
one  there  is  this  fiilure  of  the  sphincter,  and  the  entire  bowel  is 
permitted  to  descend,  yet  retaining  its  natural  relation.  In  the 
other,  the  connective  tissue  between  the    mucous  and   muscular 


PROLAPSUS  ANI.  339 

coats  is  relaxed,  or  has  given  way,  and  the  mucous  coat  is  ex- 
truded through  the  sphincter,  which  grasps  it  tightly.  In  this 
case  the  bowel  seems  as  if  turned  inside  out. 

Symptoms. — In  the  early  stages  the  child  complains  of  uneasi- 
ness about  the  rectum,  after  going  to  stool,  and  if  walking  will 
be  observed  to  keep  the  legs  separated ;  but  in  a  few  minutes 
the  bowel  naturally  retracts,  and  the  uneasiness  passes  away. 

In  the  severer  cases  there  is  tenesmus  during  and  after  going 
to  stool,  and  occasionally  the  child  suflFers  severely.  The  bowel 
requires  to  be  returned  artificially  in  order  to  give  relief.  If  this 
is  neglected  it  becomes  congested  and  swollen,  sometimes  so 
much  so,  that  days  will  be  required  to  so  reduce  its  size  as  to 
permit  a  return  through  the  sphincter.  It  is  very  easy  to  deter- 
mine what  is  the  matter  in  these  cases,  as  an  inspection  of  the 
part  shows  the  bluish  or  dusky  discolored  tumor  at  the  site  of 
the  rectum. 

When  the  disease  is  of  long  duration,  the  skin  and  mucous 
membrane  seem  too  large  for  their  purpose,  and  the  first  hangs 
in  folds  outside,  while  the  second  is  gathered  in  folds  inside.  In 
some  cases  there  is  also  an  enlargement  of  the  veins  of  the  mu- 
cous coat,  so  that  in  consequence  it  is  considerably  thickened. 

Treatment. — The  first  object,  when  called  to  a  case  of  pro- 
lapsus ani,  if  the  bowel  is  still  prolapsed,  is  to  replace  it.  This 
is  not  always  a  pleasant  job,  yet  it  can  be  accomplished,  even 
when  considerably  swollen,  if  care  is  used  and  the  physician  has 
patience.  Have  a  soft  cotton  or  linen  cloth  spread  with  lard,  and 
place  upon  the  protruding  gut,  the  little  patient  being  upon  his 
hands  and  knees,  or  more  frequently  lying  across  its  mother's 
lap,  face  down,  and  feet  depending.  Now  placing  both  hands  so 
that  one  or  two  fingers  may  rest  on  the  gut,,  the  other  fingers  and 
thumb  press  upon  the  perineum  in  such  direction  as  to  relax  it. 
Gentle  and  continued  pressure  being  made  upward,  in  a  short 
time  reduction  is  effected. 

For  the  radical  cure,  if  the  case  is  mild,  I  direct  that  the  part 
shall  be  washed  with  an  infusion  of  Hamanielis,  and  that  the 
distilled  extract  of  the  same  (Pond's)  be  given  in  doses  of  five 
or  ten  drops  three  times  a  day;  or  in  place  of  this,  we  may  give 
the  Collinsonia  in  doses  of  one  drop  three  times  a  day. 

In  some  cases  small  doses  of  Nux,  in  others  of  Colocynth,  and 


( 
340  DISEASES   OF   CHILDREN. 

in  still  others  of  Aloes,  will  relieve  the  tenesmus  that  causes  the 
prolapse,  and  will  strengthen  the  lower  bowel  and  femoral  muscles. 

In  severe  cases,  when  of  long  duration,  I  use  the  persulphate 
of  iron  as  a  local  application.  In  most  cases  one  part  of  the 
solution  to  two  or  three  parts  of  glycerine,  will  be  as  strong  as  it 
can  be  borne,  but  in  others  it  may  be  used  of  full  strength. 

The  hypodermic  injection  of  ergotin  near  the  sphincter  has 
given  excellent  results  in  cases  otherwise  incurable. 

There  are  a  few  cases  which  will  require  operative  interference. 
Two  methods  are  practiced.  In  one  the  folds  of  skin  alone  are 
removed,  in  the  other  the  entire  projecting  part — mucous  mem- 
brane and  skin.  In  the  first  case  the  operation  is  simple — the 
ordinary  silk  ligature  having  been  passed  through  the  base  of  the 
fold  in  two  or  three  places,  this  is  cut  away  with  a  pair  of  curved 
scissors  or  a  bistoury,  and  the  ligatures  tied,  bringing  the  cut 
edges  together.  Thus  four,  five,  or  six  folds  are  cut  away,  and 
when  the  part  has  cicatrized,  it  is  much  smaller  and  tense,  and 
gives  the  needed  support.  In  the  other  case  the  ligatures  are 
passed  through  the  projecting  rectum,  at  distances  of  about  one- 
half  inch  apart,  leaving  the  ends  sufficiently  long  to  tie.  The 
gut  is  then  cut  away  outside  of  the  ligatures,  and  when  these  are, 
tied  the  cut  surfaces  are  again  in  apposition,  and  cicatrization 
occurring,  a  very  firm  support  is  given,  and  the  disease  is  readily 
cured.    ' 


INTESTINAL    WORMS. 

The  presence  of  worms  in  the  intestinal  canal  is  not 
always  attended  by  symptoms  of  disease;  indeed  children  may 
enjoy  very  good  health  while  infested  with  these  parasites.  It 
has  been  claimed  that  an  entirely  healthy  person  will  not  have 
worms,  as  that  an  entirely  healthy  and  well-taken-care-of  child 
will  not  have  pedicuU.  I  think  this  is  true,  to  the  extent  that 
the  naturally  healthy  child  will  not  suffer  from  them,  and  not 
furnishing  a  comfortable  home  they  are  not  likely  to  remain. 

A  depraved  condition  of  the  intestinal  canal,  with  increased 
mucous  secretion,  seems  to  furnish  the  conditions  necessary  to 
the  propagation  of  worms,  and  as  digestion  is  necessarily  inter- 
fered with  by  this  condition,  there  will  be  more  or  less  impair- 
ment of  the  general  health. 


INTESTINAL   WORMS.  341 

Causes. — lu  olden  times  it  was  tliought  that  there  was  spon- 
taneous  generation  of  worms,  and  there  are  some  who  yet  hold  to 
tills  opinion.  The  fact  is,  there  is  no  new  creation  in  this  world; 
every  organized  body,  from  the  simplest  cell  or  monad  to  the 
highest  animal  life,  being  the  prod  net  of  parents  who  possessed 
the  same  form  and  functions.  Intestinal  worms,  therefore,  have 
a  parentage,  and  are  propagated  only  from  the  same  species. 

Tlie  subject  has  been  carefully  studied  for  many  years  by  Kuch- 
enmeister,  a  very  persevering  German  physician  and  naturalist, 
and  the  facts  are  very  clearly  established.  The  two  varieties  of 
ascaris  and  the  trichocephalus  are  produced  directly  from  ova 
taken  into  the  intestinal  canal,  which,  finding  the  conditions  for 
incubation,  are  developed  into  the  fully  formed  worm.  Previous 
to  this,  it  was  believed  that  these  vareties  were  viviparous — 
giving  birth  directly  to  the  young.  This  was  the  opinion  of  Dr. 
Good,  of  Watson,  and  others. 

The  taenia  are  oviparous,  producing  eggs  from  which  the  worms 
are  developed.  The  development,  howev^er,  requires  two  animals 
of  different  species,  in  one  of  which  the  worm  attains  its  pupa 
state,  and  in  the  second  attains  its  perfect  development.  The 
process  is  very  much  like  the  development  of  a  butterfly — from 
the  egg  to  a  grub,  from  that  to  a  fully  developed  insect. 

Kuchenmeister  traced  the  taenia  solium  from  the  cysticercus  of 
the  pig,  through  all  its  gradations  up  to  the  fully  formed  worm. 
These  cysticerci  are  very  tenacious  of  life,  and  may  get  into  the 
intestinal  canal  by  eating  raw  or  partially  cooked  fresh  pork,  or 
even  bacon. 

When  once  introduced  into  the  human  body,  a  new  develop- 
ment commences,  and  from  these  small  grub- like  bodies  are  pro- 
duced the  perfect  tape-worm.  Each  joint  of  one  of  them  con- 
tains a  multitude  of  eggs,  w^hich  being  discharged  with  the  in- 
testinal contents,  regains  its  original  habitat,  the  hog,  is  devel- 
oped into  a  cysticercus,  which  in  turn  by  transplantation  becomes 
a  t8enia.  Thus  from  the  fully  developed  worm  in  the  human  intes- 
tine is  thrown  off  the  eggs,  which,  being  taken  by  the  hog  with  its 
food  or  drink,  gains  access  to  its  tissues  and  is  developed  into  the 
cysticercus  or  grub,  and  this  being  eaten  by  men  produces  the 
perfect  worm. 

This  being  the  origin  and  mode  of  development,  we  find  that 
certain  sections  of  country  are  verviinoua,  while  others  are  com- 
paratively free.     This  has  been  remarked  in  case  of  the  tape- 


342  DISEASES  OF   CHILDREN. 

worm,  and  I  think  it  just  as  well  established  with  the  other 
forms.  When  the  conditions  are  favorable  for  the  reception  of 
the  discharged  ova  in  water  or  food,  we  will  find  that  intestinal 
worms  are  common,  and  where  these  do  not  exist  they  are  rarely 
seen. 

The  principal  varieties  of  intestinal  worms  are :  the  ascaris 
lumbricoides,  the  ascaris  or  oxyurus  vermicularis,  the  trichocephalus 
dispar,  and  the   tcenia  solium  and  vulgaris. 

The  ascaris  lumbricoides,  or  long  round  worm,  is  described  by 
Dr.  Good  as  having  a  slightly  incurvated  head,  with  a  transverse 
contraction  beneath  it;  mouth  triangular;  body  transparent; 
color,  light  yellow,  with  a  faint  line  down  the  side  ;  gregarious, 
viviparous;  from  six  to  fifteen  inches  long;  inhabits  principally 
the  ilium,  but  sometimes  ascends  into  the  stomach,  and  creeps 
out  of  the  mouth  and  nostrils ;  occasionally  travels  to  the  rec- 
tum, and  passes  away  at  the  anus. 

The  ascaris  vermicularis,  or  small  thread  worm,  has  its  habitat 
in  the  rectum,  though  it  sometimes  gets  into  the  intestines,  and 
occasionally  in  the  female,  into  the  vagina.  "  The  head  is  subu- 
late, nodose,  and  divided  into  three  vesicles,  in  the  middle  of 
which  it  receives  nourishment;  skin  at  the  sides  of  the  body 
finely  crenate  or  wrinkled  ;  tail  finely  tapering  and  terminating 
in  a  point;  gregarious,  viviparous,  and  about  half  an  inch  long." 

The  trichocephalus  dispar,  or  long  thread  worm,  is  found  in  the 
intestines,  both  large  and  small,  and  in  the  stomach,  and  especi- 
ally in  sickly  children,  and  those  who  are  poorly  nourished. 

"  The  body  is  obese,  slightly  crenate,  beneath  smooth,  finely 
striated  on  the  fore  part ;  the  head  obtuse,  and  furnished  with  a 
slender  retractile  proboscis ;  tail  or  thinner  part  twice  as  long  as 
the  thicker,  terminating  in  a  fine  hair-like  point;  about  two 
inches  long,  and  its  color  light  yellow." 

The  tcenia  solium,  or  long  tape  worm,  is  described  by  the  same 
author  "as  having  long  and  narrow  articulations,  with  niargin- 
ous  pores,  by  which  it  attaches  itself  to  the  intestines;  one  on 
each  joint,  generally  alternate ;  ovaries  arborescent ;  head  with 
a  terminal  mouth,  surrounded  with  two  rows  of  radiate  hooks  or 
holders;  and  a  little  below,  on  the  flattened  surface,  four  tuber- 
culate  orifices,  or  suckers,  two  on  each  side;  it  is  from  thirty  to 
forty  feet  long,  and  has  been  found  sixty.  Inhabits  the  intestines 
of  mankind,  generally  at  the  upper  part,  where  it  feeds  on  the 
chyle  and  juices  already  animalized.     Is  sometimes  solitary,  but 


INTESTINAL  WORMS.  343 

commonly  in  considerable  numbers;  and  adheres  so  firmly  to  the 
intestines  that  it  is  removed  with  great  difficulty.  It  is  said  to 
have  the  power  of  reproducing  that  which  has  been  broken  off; 
but  this  assertion  wants  proof.  The  animal  is  oviparous,  and 
discharges  its  numerous  eggs  from  the  apertures  in  the  joints.' 
Tiie  articulations  are  from  four  to  six  lines  in  length,  and  nearly 
as  much  in  width,  and  resemble  gourd  or  melon  seeds. 

"  The  articulations  of  the  broad  tape  worm  are  short  and  broad, 
with  a  pore  in  the  center  of  eacli  joint,  and  stellate  ovaries  around 
them ;  body  broader  in  the  middle,  and  tapering  toward  both 
ends;  head  resembling  the  last;  inhabits  the  upper  part  of  the 
intestines,  and  feeds  on  chyle ;  from  three  to  fifteen  feet  long ; 
usually  in  familes  of  three  or  four." 

Symptoms. — With  many  if  not  all  forms  of  worms,  it  is  neces- 
sary that  the  bowels  be  in  a  condition  to  furnish  a  comfortable 
habitation.  This  condition  is  essentially  one  of  want  of  tone, 
with,  in  many,  increased  secretion  of  intestinal  mucus.  We 
observe  in  many  cases  that  the  child  or  person  is  poorly  nourished, 
the  muscles  are  soft  and  flabby,  there  is  a  loaded  tongue,  bad 
breath,  and  derangement  of  the  secretions.  We  are  not  inclined 
to  believe  that  this  is  the  result  of  worms,  but  simply  coincident 
with  Ihem,  and  in  some  cases  the  patient  has  what  is  termed 
worm  fever,  usually  of  an  intermittent  character,  the  paroxysms 
occuring  in  the  afternoon  and  evening,  at  which  time  we  find  the 
skin  hot  and  dry,  the  pulse  frequent,  the  head  hot,  and  marked 
irritability  and  restlessness,  and  occasionally  convulsions.  Or 
the  fever  may  be  more  obscure,  the  child  is  fretful  and  nervous, 
sleeps  poorly,  its  breath  is  fetid,  tongue  coated,  bowels  irregular, 
abdomen  tumid,  is  frequently  picking  its  nose,  the  upper  lip 
swells,  a  white  line  appears  around  its  mouth  and  it  seems  to  be 
out  of  order  generally.  These  are  the  symptoms  of  the  first 
named  varieties,  though  not  nearly  so  well  marked  in  the  case  of 
the  ascaris  vermicularis.  Thougli  seeming  to  be  very  plain,  yet 
all  these  symptoms  may  be  present  and  no  worms;  or  worms 
present,  and  but  few  of  these  symptoms.  The  only  certain  evi- 
dence of  worms  is  their  presence  in  the  feces,  and  even  then  we 
can  not  be  certain  but  that  all  have  passed.  The  ascaris  vermi- 
cularis makes  itself  known  by  an  intolerable  itching  and  crawl- 
ing sensation  about  the  anus.  At  first  it  generally  comes  on 
after  the  little  patient  gets  warm  in  bed,  the  irritation   being  so 


344  DISEASES  OF    CHILDREN. 

great  that  sleep  is  impossible;  at  last,  they  are  more  or  less 
troublesome  all  the  time.  The  irritation  is  occasionally  so  great 
as  to  impair  the  health,  and  occasionally  gives  rise  to  convulsions. 
As  regards  the  symptoms  of  tape-worm,  they  are  very  decep- 
tive. In  one  hundred  cases  recorded  by  Seeger,  in  sixty-eight 
instances  nervous  affections,  or  general  or  partial  convulsions, 
occurred — epilepsy,  hysteria,  abdominal  spasms,  convulsive  cough, 
dyspnoea,  melancholy,  and  hypochondriasis ;  in  forty-two,  vari- 
ous pains  in  the  abdomen ;  in  thirty-three,  disordered  digestion 
and  irregular  states  of  the  evacuations ;  in  thirty-one,  irregular 
appetite  and  voracity ;  in  nineteen,  habitual  or  periodical  hemi- 
cranias ;  in  seventeen,  sudden  colic;  in  sixteen,  sensations  of 
undulatory  movements  in  the  abdomen  up  to  the  chest;  in  fifteen* 
vertigo,  delusions  of  the  senses,  and  defects  of  speech ;  and  in 
eleven,  shifting  pains  in  various  parts.  The  only  definite  evi- 
dence of  the  presence  of  tape-worm  is  the  passage  of  portions  of 
it  with  the  feces,  and  as  this  usually  occurs  with  this  worm,  the 
non-appearance  of  the  joints  in  the  evacuations  during  a  consid- 
erable time,  may  be  considered  as  good  evidence  that  the  worms 
do  not  exist  in  the  intestinal  canal.    . 

Treatment. — The  treatment  of  the  ascaris  lumbricoides  and 
trichocephalus  will  be  very  similar,  the  object  being  to  remove 
the  worms,  and  break  up  the  predisposition  to  them  by  remov- 
ing the  condition  on  which  they  depend.  Very  many  vermifuge 
remedies  have  been  recommended  and  used  with  success,  so  that 
the  trouble  will  be,  not  that  we  have  no  remedies,  but  that  we 
have  too  many.  The  old  fashioned  remedy,  "  pink  and  senna" 
in  infusion,  seemed  to  be  about  as  certain  as  any  other  agent,  and 
I  am  satisfied  that  if  it  were  as  disgusting  to  the  worm  as  it  is  to 
the  child,  it  would  readily  leave  its  nest  in  the  bowels,  rather 
than  take  the  dose.  Still  it  is  not  more  nauseous  than  the  oil  of 
wormseed,  which  is  an  ingredient  of  all  the  principal  vermifuges, 
as — 1^  Oleum  Chenopodii  5x.,  Oleum  Terebinthinse  .^ij.,  Oleum 
Rieinii  .^iij..  Aqua  Calcis  §x.,  Syrupus  Limonis  5vj. ;  Mix;  the 
dose  being  two  teaspoonfuls  three  or  four  times  a  day.  Knchen 
meister  recommends  the  santonine,  and  the  santonate  of  soda, 
for  the  ascaris  lumbricoides;  he  considers  it  to  be  best  adminis- 
tered in  oil,  in  order  to  bring  it  into  solution  as  readily  as  possi- 
ble, and  thus  combines  it  with  castor  oil,  or  sprinkles  it  on  bread 
and  butter,  and  follow  it  with  Jalap  and  Senna.     Troublesome 


INTESTINAL  WORMS.  345 

effects  sometimes  follow  the  administration  of  this  remedy,  as 
severe  irritation  of  the  nervous  system,  convulsions,  tenesmus, 
bloody  stools,  and  the  minor  disturbances,  green  or  bluish  vision, 
and  discoloration  of  the  urine.  The  santonate  of  soda  he  gave 
in  doses  of  from  two  to  six  grains  on  a  Friday  night,  and  the 
same  dose  on  Saturday  and  Sunday  mornings,  fasting;  half  an 
hour  after  this  last  powder,  confection  of  Senna  and  Jalap  is  taken 
in  sufficient  doses  to  produce  several  fluid  evacuations,  the  worms 
passing  alive,  and  sometimes  wandering  forth  without  any  opera- 
tion, the  intestines  having  become  unpleasant  for  them. 

I  now  employ  a  trituration  of  Santonine  with  Podophyllin  in 
the  following  proportion — I^  Podophyllin  gr.  j.  to  ij.,  Santonine 
gr.  X.  to  gr.  XX.,  White  Sugar  o'j- ;  triturate  and  make  twenty 
powders.  One  of  these  may  be  given  morning  and  night,  until 
the  object  is  accomplished.  When  there  are  no  worms,  but  only 
the  atonic  condition  of  the  mucous  membrane  with  increased 
secretion  of  mucus,  the  patient  will  be  benefited,  and  sometimes 
cured  by  the  remedy. 

A  judicious  tonic  course  of  medicine,  the  bowels  being  kept 
regular,  and  the  other  secretions  free,  with  an  avoidance  of  all 
grease  or  indigestible  food,  the  daily  use  of  the  bath,  and  exercise 
in  the  open  air,  are  the  only  means  by  which  we  can  break  up 
the  tendency  to  the  formation  of  worms. 

Many  remedies  have  been  recommended  for  the  ascaris  vermi- 
cularis,  but  in  my  opinion  all  vermifuge  medicines  should  be  dis- 
carded. If  the  patient's  bowels  are  irregular,  proper  means 
should  be  taken  to  overcome  the  difficulty,  and  if  necessary  a 
tonic  and  bracing  treatment  adopted.  For  the  worms  I  have 
always  directed  an  injection  of  salt  and  cold  water,  in  the  pro- 
portion of  a  teaspoonful  to  half  a  teacupful,  and  so  far  with  in- 
variable success. 

Should  this  fail,  we  will  be  able  to  relieve  the  patient  by  the 
use  of  an  aloetic  purgative,  as  in  the  following  formula :  1^ 
Tincture  of  Aloes,  Compound  Tincture  of  Lavender,  aa.  5ss., 
Simple  Syrup  .5j. ;  a  teaspoonful  four  times  a  day. 

Tape-worm  is  of  very  rare  occurrence  in  childhood,  and  is 
possibly  never  met  with  during  the  first  two  or  three  years.  The 
mildest  treatment  will  be  best  here,  and  I  would  recommend  the 
emulsion  of  pumkin  seed,  or  the  oil  of  male  fern.  The  emulsion 
is  made  by  depriving  two  ounces  of  the  seed  of  their  capsules, 
and  beating   them  into  a  pulp,  with  sugar  and  water;  this  is  the 


346  '      DISEASES   OF   CHILDREN. 

dose  for  an  adult,  and  is  taken  upon  an  empty  stomach,  in  tlie 
morning;  and  is  followed  in  from  two  to  four  hours  by  a  full 
dose  of  castor  oil.  The  oil  of  male  fern  is  also  taken,  fasting, 
the  dose  being  from  gtt.  xx.  to  5j.    in  mucilage  of  milk. 

The  most  effective  means  for  the  removal  of  tape-worm  will 
be  found  in  the  Pomegranate  bark,  according  to  the  directions  of 
Prof  Locke,  a  full  description  of  which  may  be  found  in  my 
Practice  of  Medicine. 


DISEASES   OF   THE    LIVER. 

In  the  olden  time,  diseases  of  the  liver  were  the  most  promi- 
nent affections  of  both  adults  and  children,  and  would  occupy  a 
conspicuous  place  in  treatises  upon  the  subject.  But  as  v/e  have 
learned  more  and  theorized  less,  the  liver  has  played  a  less  im- 
portant part  in  pathology,  and  has  received  less  attention  from 
the  therapeutist. 

We  have  reason  to  believe  that  the  intra-uterine  function  of 
the  liver  is  of  more  importance  than  its  function  after  birth. 
For,  of  all  the  organs  of  the  body,  it  alone  had  its  complete  de- 
velopment before  birth,  and  in  size  was  much  larger  than  any 
other  organ  in  proportion  to  the  body.  What  its  functions  were 
there,  we  are  as  much  unable  to  say  as  what  its  functions  are  in 
the  adult ;  but  of  one  thing  we  are  convinced,  that  it  is  so  admi- 
rably adapted  to  its  office  that  it  rarely  suffers  from  serious 
disease. 

CONGESTION   OF   THE   LIVER. 

We  notice  a  singular  disease,  occurring  during  the  first  three 
or  four  months  of  infancy,  in  which  there  is  enlargement  of  the 
right  hypochondrium  and  the  epigastrium.  It  is  known  by 
nurses  and  old  ladies  as  liver-grown,  and  they  propose  its  remo- 
val by  rubbing  with  some  fatty  material — generally  goose-grease. 
That  there  is  such  enlargement  there  can  be  no  doubt,  and  that 
it  is  relieved  by  these  frictions  is  also  certain,  but  what  the  exact 
condition  is,  I  have  never  been  able  to  determine.  The  symp- 
toms would  indicate  congestion  of  the  liver,  hence  I  have  given 
it  that  name. 


CONGESTION  OF  THE  LIVEE.  347 

Symptoms. — For  some  days  the  child  has  been  fretful  and 
uneasy,  seeming  to  sutJ'er  from  indigestion  and  colic.  The  dis- 
charges from  the  bowels  are  more  frequent,  and  have  an  un- 
healthy appearance,  generally  light-colored.  At  last  the  child  is 
undoubtedly  sick,  has  some  fever,  does  not  sleep  well,  is  startled 
in  its  sleep  and  cries  out  as  if  in  pain.  It  does  not  nurse  well, 
and  usually  feels  uneasy  after  taking  the  breast,  and  relieves 
itself  by  throwing  up  its  milk.  This  has  an  unpleasant  sour 
smell,  and  is  not  curded  as  in  healthy  digestion. 

The  symptoms  named  may  continue  for  some  weeks,  the  child 
losing  flesh  and  becoming  quite  feeble;  and  I  doubt  not,  though 
I  have  never  observed  it,  that  this  condition  might  continue  to  a 
fatal  termination. 

Diagnosis. — With  the  symptoms  above  given,  which  resemble 
those  of  infantile  dyspepsia,  we  will  find  a  distinct  enlargement 
of  the  right  hypochondrium.  A  careful  examination,  with  pal- 
pation, will  show  the  liver  to  be  really  enlarged,  as  its  outlines 
can  be  distinctly  traced. 

Treatment. — As  named  above,  the  treatment  of  the  nurse  is 
usually  quite  successful,  and  this  is  simply  the  thorough  rubbing 
of  the  part  with  some  oily  material.  In  the  hands  of  an  old 
lady,  the  treatment  is  very  vigorous,  with  rubbing,  kneading,  and 
paljjation,  the  child  being  turned  from  side  to  side,  now  on  its 
abdomen,  then  on  its  back,  and  this  continued  for  a  quarter  or 
half  hour,  and  repeated  every  day,  and  sometimes  twice  a  day. 

On  first  witnessing  it  I  thought  it  pretty  rough  usage  for  a 
delicate  and  sick  infant,  and  protested  against  it.  But  the  old 
nurse  insisted  that  doctors  were  fools,  and  would  have  her  own 
way,  and  the  result  justified  her  claim  to  be  able  to  treat  liver- 
grown,  for  the  child  made  a  quick  recovery. 

I  learned  one  lesson  from  this,  that  I  have  put  in  practice 
many  times  since  with  success — that  torpid  organs  could  be  stim- 
ulated to  action  by  passive  movements,  and  their  circulation  and 
nutrition  decidedly  improved.  This  is  the  principle  of  the  Swe- 
dish "movement  cure,"  which  is  claimed  to  be  as  well  adapted  to 
a  dyspeptic  stomach,  as  to  an  enfeebled  limb. 

The  remedies  I  would  advise  in  this  case  are — I^  Tinct.  Bel- 
ladonna, Tine.  Aconite,  aa.  gtt.  iij.,  water  5iv.;  one-fourth  to 
one-half  teaspoonful  every  hour.  If  it  was  somewhiat  chronic, 
having    lasted    for  some  weeks,  small   doses  of  Nux  might  be 


348  DISEASES  OF   CHILDREN. 

given,  or  if  there  was  still  irritation,  the  tincture  of  Chionauthus 
in  drop  doses  every  three  hours. 

If  the  child  is  feeble,  and  especially  if  suffering  from  a  mala- 
rial influence,  quinine  inunction  would  be  advisable.  In  all  cases 
I  would  advise  the  thorough  rubbing  of  the  part,  as  first  named. 

STRUMOUS  ENLARGEMENT  OF  THE  LIVER. 

This  is  not  of  frequent  occurrence,  but  may  be  occasionally 
met  with  in  the  children  of  the  poor  in  large  cities,  as  the  result 
of  jjoor  and  scanty  food,  bad  air,  want  of  sunlight,  want  of  clean- 
liness, proper  clothing,  warmth,  and  indeed  all  that  we  are  accus- 
tomed to  regard  as  the  comforts  of  life.  Rarely  a  case  occurs  in 
a  family  in  good  circumstances,  from  scrofula  or  bad  blood,  or 
from  the  depression  of  other  sickness. 

Dr.  Tanner  observes  "that  a  peculiar  enlargement  of  this  gland 
not  unfrequently  occurs  in  feeble  and  delicate  children.  The 
abdomen  gradually  enlarges,  so  that  the  little  patient  is  said  to 
be  ^pot-bellied,' and  on  examination  one  or  more  well  defined 
tumors  are  discovered.  These  tumors  are  formed  by  the  enlarged 
liver,  with  perhaps  an  enlarged  spleen ;  the  increase  in  size  in 
both  cases  being  due  to  the  interstitial  deposit  of  albuminous 
matter.  As  this  foreign  matter  is  soft,  and  has  no  tendency  to  con- 
tract like  the  lymph  poured  out  in  ordinary  inflammation,  it  does 
not  much  impede  the  passage  of  the  blood  through  the  liver,  or 
the  escape  of  bile  through  the  ducts ;  and  hence  it  very  seldom 
gives  rise  to  serious  disturbance.  Should  the  same  material, 
however,  become  deposited  in  the  structure  of  the  kidneys,  then 
the  function  of  these  glands  becomes  so  completely  interfered 
with  that  the  cases  cease  to  be  amenable  to  treatment,  and  albu- 
minuria, ascites,  and  anasarca  ensue,  and  death  ultimately 
results." 

Symptoms. — The  child  has  lost  flesh  in  a  very  marked  degree, 
though  it  is  usually  not  so  feeble  as  we  should  suppose  by  its  ap- 
pearance. Its  appetite  is  variable  ;  sometimes  craving,  especially 
for  fruits,  sweets,  pastry,  and  things  it  should  not  have ;  at  others 
it  wants  to  eat  but  little.  Digestion  is  accomplished  tolerably 
well,  so  far  as  we  can  observe  from  any  derangement  of  stomach 
or  bowels,  following  the  taking  of  food.  But  it  is  imperfect  in 
that  the  material  is  deteriorated  during  the  digestive  act,  and  can 
not  make  good  blood  or  good  tissue. 


ENLARGEMENT  OF  THE  LIVER.  349 

Generally,  there  is  more  or  less  derangement  of  the  bowels, 
the  disciiarges  being  too  frequent,  attended  with  uneasiness,  and 
are  liglit-colored.  The  urinary  secretion  is  somewhat  scanty, 
highly  colored,  and  sometimes  presenting  distinct  evidence  of  the 
coloring  matter  of  bile.  The  skin  is  generally  sallow,  relaxed, 
and  hangs  in  folds,  the  circulation  being  sluggish,  and  secretion 
imperfect. 

In  the  majority  of  cases  there  is  slight  febrile  action  in  the 
after  part  of  the  day,  and  the  child  is  restless  and  fretful  at  night, 
wanting  to  drink  often.  In  some  cases  an  unpleasant  irritation 
of  the  nervous  system,  causing  the  child  to  be  restless  and  fretful 
and  sleeping  badly,  is  the  most  unpleasant  symptom. 

Diagnosis. — The  distended  abdomen,  so  large  as  compared 
with  the  general  loss  of  flesh,  and  the  distinct  enlargement  in  the 
region  of  the  liver,  its  lobes  being  felt  as  distinct  tumors,  is  suffi- 
cient. In  tabes  mesenterica  there  Is  a  somewhat  similar  enlarge- 
ment of  the  abdomen,  but  it  is  most  prominent  in  the  region  of 
the  umbilicus,  and  the  nodulated  glands  may  also  be  felt  in  the 
mesentery. 

Prognosis. — When  of  long  duration,  and  attended  with  great 
marasmus,  the  prognosis  is  unfavorable.  But  if  the  child  has 
considerable  strength,  and  digestion  is  not  much  impaired,  we  may 
expect  favorable  results  from  the  use  of  remedies. 

Treatment. — I  have  much  faith  in  a  judicious  tonic  and  re- 
storative treatment,  in  all  these  cases,  paying  particular  attention 
to  the  clothing,  food,  and  that  it  has  an  abundant  supply  of  sun- 
shine and  fresh  air. 

The  internal  administration  of  Colllnsonia  and  Hamamells  al- 
ternated, in  the  doses  heretofore  named,  will  be  found  to  quiet 
irritation  of  the  bowels,  check  the  frequency  of  the  discharges 
and  change  their  character.  Associated  with  this,  I  would  give 
the  tincture  of  muriate  of  Iron  with  glycerine  morning  and  night. 

Let  the  child  be  thoroughly  rubbed  twice  a  day  with  the  quinia 
Inunctfon,  freeing  the  surface  from  any  surplus  material  by  rub- 
bing with  clean  flannel,  and  occasionally  by  washing  with  soap 
and  water.  This  I  consider  one  of  the  most  important  parts  of 
the  treatment. 

The  child  should  be  clothed  in  flannel  throughout,  both  winter 
and  summer,  and  in  chilly  or  cold  weather,  especial  care  should  • 


350  DISEASES  OF  CHILDREN. 

be  used  to  keep  it  warm,  and  in  an  atmosphere  of  uniform  tem- 
perature. The  room  where  it  sleeps  should  be  thorougly  venti- 
lated, and  have  a  good  supply  of  sunshine,  and  in  addition  the 
child  should  be  carried  in  the  open  air. 

The  food  may  be  the  same  as  recommended  in  cholera  infantum, 
and  should  be  carefully  prepared.  Sometimes  more  will  depend 
upon  this  than  upon  the  treatment.  For  a  poor  and  bad  blood 
must  increase  the  disease,  while  from  good  food,  well  digested, 
good  blood  is  formed,  capable  of  supplying  the  tissues,  and  giv- 
ing no  waste  for  struma. 

JAUNDICE. 

We  have  two  varieties  of  jaundice  in  childhood  which  require 
separate  description.  The  first,  or  icterus  neonatorum — the  jaun- 
dice of  infancy — is  usually  a  very  simple  affection,  and  though  of 
frequent  occurrence,  it  passes  away  with  simple  treatment.  The 
second  variety  resembles  the  jaundice  of  the  adult,  both  in  its 
pathology  and  symptoms,  and  while  of  rare  occurrence  it  is 
sometimes  a  severe  affection. 

Causes. — The  causes  of  the  first  form  are  very  obscure,  and 
while  occasionally  it  seems  to  arise  from  some  irritation  of  the 
primce  vice,  in  other  cases  there  is  no  apparent  cause  for  it. 

The  second  form  of  jaundice  may  be  caused  by  cold,  produc- 
ing congestion  of  the  internal  organs,  aud  especially  of  the  por- 
tal circle.  Or  it  may  be  produced  by  a  malarial  poison,  which, 
impairing  the  circulation  of  blood,  causes  congestion  of  the  ab- 
dominal viscera. 

Pathology. — Jaundice  is  but  a  symptom  of  some  lesion  of 
the  liver  or  of  the  blood.  It  consists  in  a  change  of  the  coloring 
material  of  the  blood,  and  its  being  set  free  and  deposited  in  the 
tissues ;  or  more  frequently  in  the  retention  and  absorption  of 
the  coloring  matters  of  the  bile,  and  their  deposit  in  various 
structures,  principally  the  skin  and  conjunctiva.  Occasionally 
it  is  deposited  in  the  deeper  structures,  as  of  the  eye,  giving 
rise  to  yellow  vision  ;  in  the  nails,  and  in  the  internal  organs. 

It  is  singular  that  the  mildest  and  the  severest  form  of  jaun- 
dice are  alike,  in  that  they  are  dependent  upon  change  in  the 
coloring  material  of  the  blood.  In  icterus  neonatorum  I  regard 
the  coloring  matter  deposited  in  the  skin,  as  arising  from  the 
natural  retrograde  metamorphosis  of  the  red  globules,  but  fail- 


JAUNDICE.  351 

ing  to  be  removed,  from  some  temporary  inactivity  of  the  excre- 
tory organs.  All  the  symptoms  point  to  this  as  the  true  condi- 
tion, for  in  the  majority  of  cases,  there  is  no  lesion  of  the  diges- 
tive canal  or  its  associate  organs,  all  their  functions  being  car- 
ried on  regularly  and  well ;  while  in  those  cases  in  which  there 
is  such  irritation,  it  seems  rather  from  arrest  of  excretion  than 
from  any  other  cause. 

In  those  extreme  cases  of  jaundice,  running  a  regular  and 
very  certain  course  to  a  fatal  termination,  the  coloring  material 
is  changed  hematine  and  not  bile.  In  this  respect  it  resembles 
the  bronzed  discoloration  in  Addison's  disease  (disease  of  the  su- 
prarenal capsules). 

The  other  form  of  jaundice  arises  from — a,  hypersecretion  of 
bile;  6,  from  congestion  of  the  liver  and  portal  system  ;  c,  from 
chronic  alterations  of  the  structure  of  the  liver,  preventing  se- 
secretion  or  the  free  discharge  of  bile  ;  d,  from  spasm  or  tempo- 
rary obstruction  of  the  biliary  ducts;  e,  from  obliteration  or 
compression  of  the  biliary  ducts  or  gall-bladder; /,  and  lastly, 
from  disease  of  the  duodenum,  partially  or  entirely  occluding  the 
ductus  communis. 

Symptoms. — Icterus  neonatorum  is  frequently  attended  at  first 
by  slight  febrile  action.  Occasionally  this  is  quite  marked,  and 
the  child  is  restless  and  uneasy,  and  sleeps  badly,  continuing  for 
from  one  to  four  or  five  days,  in  a  remittent  form  ;  it  gradually 
passes  away,  and  the  secretions  being  restored,  the  child  seems  as 
well  as  ever,  but  for  the  yellow  discoloration.  It  will  be  recol- 
lected that  in  the  majority  of  cases  the  fever  is  not  high,  and 
passes  off  entirely  by  the  end  of  the  second  day. 

The  yellow  discoloration  very  gradually  fades,  seeming  to  be 
removed  more  by  the  natural  removal  of  tissue  than  by  special 
absorption.  Rarely  continuing  less  than  two  weeks,  it  may  not 
be  entirely  removed  for  as  much  as  three  months. 

The  other  form  of  the  disease  rarely  occurs  during  the  first  or 
even  the  second  year.  Usually,  there  is  distention  of  the  bow- 
els, colicky  pains,  constipation,  the  feces  being  clayey,  pale,  and 
scanty.  The  mouth  is  dry,  has  a  bad  taste,  tongue  coated,  and 
sometimes  nausea  and  pain  in  the  head.  The  yellow  tinge  usu- 
ally makes  its  appearance  in  the  eyes,  and  gradually  extends  to 
all  parts  of  the  body,  the  color  being  deepest  in  the  folds  of  the 


352  DISEASES   OF    CHILD  HEX. 

For  practical  purposes,  we  may  divide  this  variety  into  two 
forms,  the  symptoms  being  distinctive  and  the  treatment  different. 
In  the  one  case  the  patient  is  irritable  and  restless,  the  skin  is 
dry  and  harsh,  the  urine  high-colored,  the  pulse  hard  and  in- 
creased in  frequency,  and  the  temperature  elevated.  In  some 
cases  the  patient  complains  of  pain  in  the  right  hypochondria 
and  in  the  shoulders,  and  sometimes  in  the  small  of  the  back. 

In  the  second  case  the  tongue  is  broad,  palid,  and  covered 
with  a  uniform  yellowish-white  coat.  The  patient  is  dull  and 
sluggish,  and  has  an  inclination  to  sleep.  The  bowels  are  swol- 
len, but  not  tender,  the  extremities  cold,  the  skin  inelastic,  and 
the  discoloration  not  bright,  as  in  the  preceding  case,  the  pulse 
soft  and  oppressed.  In  the  first  form  there  was  febrile  action,  in 
this  the  opposite  state. 

D1A.GNOSIS. — The  diagnosis  of  jaundice  is  easily  made.  The 
yellow  discoloration  is  so  unlike  anything  else  met  with,  if  we 
.except  Addison's  disease,  which  never  occurs  in  childhood,  that 
no  mistake  can  be  made.  Icterus  neonatorum  occurs  during  the 
first  few  weeks  of  life,  and  may  be  determined  by  this.  The 
pathological  conditions,  giving  rise  to  jaundice  proper,  will  be 
determined  by  the  symptoms  named  above. 

Prognosis. — The  prognosis  of  the  jaundice  of  children  is  very 
favorable.  While  it  is  sometimes  very  persistent,  especially  the 
first  form,  there  is  but  very  little,  if  any  danger,  except  from  in- 
judicious medication.  The  second  form  yields  readily  to  appro- 
priate treatment. 

Treatment. — For  icterus  neonatorum  I  should  prescribe  tinc- 
ture of  Aconite  in  the  usual  doses,  aiding  it  with  the  general  bath, 
the  general  hot  bath,  or  the  hot  foot-bath.  When  the  fever  de- 
clines I  should  direct  that  an  infusion  of  Asclepias  be  given  in 
addition.  It  will  be  recollected  that  saffron  has  been  the  reme- 
dy of  old  women  and  nurses  for  centuries,  and  there  is  no  doubt 
but  that  benefit  has  been  obtained  from  it.  Its  action  was  dia- 
phoretic. The  treatment  I  have  named  restores  all  the  secre- 
tions, but  acts  especially  upon  tlie  skin. 

In  the  first  variety  of  jaundice  proper,  with  fever,  partial  ar- 
rest of  the  secretions,  and  with  an  irritation  and  determination 
to  the  liver,  I  would  advise  the  following  course:  Put  the  pa- 
tient upon  the  use  of  tincture  of  Veratrum  or  Aconite,  the  usual 


JAUNDICE.  353 

doses,  adding  Gelseminum,  if  there  is  irritation  of  the  urinary  ap- 
parulu.s,  and  uneasiness  in  passing  urine.  Associated  with  this, 
the  tincture  of  Chiouanthus  may  be  given  in  doses  of  from  one 
to  five  drops  every  three  hours,  according  to  the  age  of  the  pa- 
tient. The  Chionanthus  is  as  nearly  a  specific  for  jaundice  as  a 
remedy  can  be  for  a  named  disease.  The  patient  should  have 
the  general  bath  and  hot-foot  bath,  to  aid  the  action  of  the  seda- 
tives, and  the  wet  pack  to  the  right  hypochondrium,  or,  better, 
an  entire  abdominal  pack  to  relieve  the  irritation  of  the  liver. 

This  plan  should  be  followed  up,  without  addition,  until  the 
pulse  has  lost  its  frequency  and  hardness,  and  the  skin  is  be- 
coming soft  and  active,  and  urinary  secretion  more  free.  If  need 
be  we  now  add  to  this  a  solution  of  acetate  of  potash  in  doses 
proportioned  to  the  age  of  the  patient.  We  watch  its  action  at 
first,  that  it  does  not  irritate  the  kidneys,  and  as  it  acts  kindly 
increase  its  quantity. 

We  observe  as  the  febrile  action  passes  off,  and  the  urinary 
secretion  is  re-established,  that  the  discoloration  commences  to 
fade.  The  reason  is  obvious,  as  the  urine  is  highly  charged  with 
coloring  matter,  so  much  so  as  to  stain  the  linen.  Indeed,  in  all 
cases  of  jaundice,  the  coloring  material  is  principally  removed  by 
the  kidneys,  and  not,  as  generally  thought,  by  the  liver. 

In  the  second  form  there  is  an  atonic  condition,  with  conges- 
tion of  the  liver,  and  a  failure  on  its  part  to  remove  the  biliary 
material  from  the  blood;  or,  having  secreted  it,  it  is  prevented 
from  passing  to  its  usual  destination  by  the  engorgement  of  the 
viscus,  and  is  re-absorbed  into  the  circulation,  and  from  tlience 
deposited  in  the  tissues.  In  this  case  we  may  give  mild  cathar- 
tics, especially  such  remedies  as  act  as  special  stimulants  to  the 
liver!  Small  doses  of  podophyllin  and  leptandrin,  thoroughly 
triturated  with  sugar,  or  bitartrate  of  potash,  may  be  given  with 
advantage,  until  they  have  produced  the  desired  effect.  In  place  of 
this,  small  doses  of  Nux  may  be  given,  and  the  region  of  the 
liver  thorougly  rubbed  with  quinine  and  lard,  or  if  there  is  marked 
fullness,  or  the  patient  has  suffered  with  malarial  disease  the  in- 
unction will  be  with  ointment  of  Uvedalia. 

This  is  followed  by  the  bitter  tonics,  hydrastine,  quinine,  or 
remedies  of  like  character,  and  some  pleasant  preparation  of  iron. 
Stimulant  baths  with  friction,  are  employed  to  obtain  an  equal 
circulation,  and  stimulant  frictions  to  the  region  of  the  liver,  to 
excite  it  to  action. 
23 


354  DISEASES  OF   CHILDREN. 

Having  obtained  these  influences  and  restored  the  functions  of 
the  liver  and  intestinal  canal,  we  have  still  to  promote  the  re- 
moval of  the  coloring  matter  from  the  skin.  This  is  accom- 
plished, as  in  the  preceding  case,  by  the  use  of  a  saline  diuretic, 
acetate  of  potash  or  citrate  of  potash  being  preferable. 

PERITONITIS. 

Peritonitis  is  of  rare  occurrence  as  an  idiopathic  disease,  both 
in  the  adult  and  child.  As  a  secondary  disease  it  may  arise  du- 
ring the  progress  of  fevers,  or  from  diseases  of  the  intestinal  ca- 
nal, and  is  met  with  more  frequently. 

Usually  but  a  comparatively  small  portion  of  the  peritoneum  is 
involved  in  the  disease ;  in  some,  however,  a  large  portion  is 
involved,  and  the  disease  is  consequently  very  severe. 

Causes. — The  cause  of  idiopathic  peritonitis  is  most  com- 
monly cold  and  arrest  of  secretion.  In  febrile  diseases  it  is 
difficult  to  determine  why  a  particular  part  is  selected  as  the 
seat  of  the  local  disease,  and  we  must  be  satisfied  with  the  sim- 
ple knowledge  of  the  fact.  In  diseases  of  the  intestinal  canal, 
or  abdominal  viscera,  the  peritonitis  is  an  extension  of  the  in- 
flammation of  the  part  first  diseased.  We  have  still  the  excep- 
tional cases  where,  from  perforation  of  the  intestinal  canal  or 
stomach  by  ulcers,  there  is  an  escape  of  their  contents  into  the 
peritoneal  cavity,  and  inflammation  as  the  result. 

Pathology. — In  infl.ammation  of  serous  membranes  the  ex- 
udation is  upon  the  free  surface,  and  the  change  of  structure 
noticed,  is  from  organization  and  change  in  this.  The  inflamma- 
tion is  usually  active  in  its  character,  and  the  exudation  plastic. 
We  have  as  yet  no  reasonable  theory  why  this  extremely  thin 
and  delicate  membrane,  into  which  nerves  can  scarcely  be  traced, 
and  which  ordinarily  has  no  sensation,  becomes  so  exquisitely 
sensitive  and  painful. 

Post-mortem  examination  shows  the  peritoneum  thickened  and 
opaque,  having  lost  its  smooth  and  even  appearance.  The  lymph 
thrown  out  is  in  every  state  of  organization,  from  a  thin  film 
upon  the  surface  to  strong  bands,  which  tie  parts  together,  or 
agglutinate  adjacent  parts.  In  some  cases  there  is  an  abundant 
serous  fluid  in  the  peritoneal  cavity,  at  others  more  or  less  pus. 


PERITONITIS.  355 

Symptoms. — In  idiopathic  peritonitis  the  inflammation  is  ush- 
ered in  with  a  chill,  followed  by  high  febrile  action.  The  sur- 
face is  hot  and  dry,  the  pulse  frequent,  small  and  hard,  with  much 
irritation  of  the  nervous  system.  The  countenance  has  an  anx- 
ious and  restless  expression,  and  is  frequently  contracted  as  if 
from  severe  pain.  The  thighs  are  flexed  upon  the  abdomen, 
and  the  body  flexed  to  take  off  the  extension  of  the  abdominal 
muscles. 

In  all  cases  the  abdomen  is  tense  and  hot,  and  more  or  less 
tympanitic.  There  is  marked  tenderness  on  pressure,  even  the 
weight  of  the  covering  producing  pain  in  the  severe  cases,  and 
slight  movements  elicit  cries  from  suffering. 

As  the  disease  approaches  a  fatal  termination,  the  pulse  be- 
comes very  frequent,  small,  and  thready  ;  the  countenance  is  con- 
tracted and  anxious,  and  the  abdomen  much  distended,  though 
there  is  less  sensibility  to  pressure. 

Diagnosis. — The  diagnosis  of  peritonitis  is  made  from  the 
symptoms  of  acute  inflammation  within  the  abdominal  cavity, 
with  tenderness  on  pressure,  and  tympanitis ;  at  the  same  time 
the  fever  being  active,  and  the  pulse  frequent,  and  unnaturally 
small  and  hard. 

Prognosis. — The  prognosis  is  not  unfavorable,  except  in  those 
cases  in  which  it  is  associated  with  some  other  severe  lesion. 

Treatment. — The  patient  is  put  upon  the  use  of  Aconite  or 
Veratrum,  as  the  pulse  is  large  or  small,  with  Rhus,  Bryonia, 
Asclepias,  Viburnum,  Colocynth,  etc.,  according  to  special  indi- 
cations. If  the  bowels  are  loose.  Ipecac  or  Euphorbia  are  com- 
bined with  the  Aconite.  If  there  is  the  expressionless  mouth 
with  nausea  and  pain  simulating  colic,  ISTux  may  be  alternated 
with  Aconite. 

The  hot  foot-bath  may  be  used  at  first,  but  in  severe  cases  it  is 
better  to  use  hot  bricks,  wrapped  in  cloths  wrung  out  of  vinegar 
and  water.  When  we  can  depend  upon  good  nursing  we  order 
hot  hop  fomentations  to  the  bowels,  but  if  we  can  not  depend  upon 
their  being  continuously  and  carefully  applied,  it  will  be  better 
to  order  a  mush  poultice. 

If  the  pain  is  very  severe,  and  is  not  controlled  by  the  means 
named,  enemas  containing  opium  may  be  employed.  Five  to 
twenty  drops  of  tincture  of  opium  may  be  used  with  two  table- 


I 


356  XflSEASES   OF   CHILDREN. 

spoonfuls  of  starch  water  or  mucilage,  and  will  give  great  relief. 
I  think  it  much  better  than  to  give  opium  by  mouth,  and  we  can 
not  well  resort  to  the  hypodermic  use  of  morphia,  which  I  prefer 
in  this  disease  of  the  adult. 


HERNIA. 

Hernia,  or  rupture,  in  the  child  is  of  frequent  occurrence,  and 
may  be  through  any  of  the  natural  openings  in  the  abdominal 
wall,  or  may  be  direct  from  the  feebleness  of  the  structures. 
Hernia  is  of  more  frequent  occurrence  in  the  male,  the  intestine 
passing  down  through  the  inguinal  canal.  It  is  of  rare  occur- 
rence in  the  female  through  the  femoral  ring. 

Inguinal  Hernia. —  Inguinal  hernia  is  of  most  frequent 
occurrence.  In  the  majority  of  cases  the  bowel  passing  through 
the  internal  abdominal  ring,  traverses  the  inguinal  canal,  passing 
through  the  external  abdominal  ring,  and  finally  makes  its  way 
into  the  scrotum. 

Attention  is  drawn  to  the  child  by  its  cries  and  evidence  of 
severe  suffering,  and  to  the  abdomen  by  its  contortions,  and  by 
the  lower  extremities  being  forcibly  flexed  upon  it.  A  careful 
examination  detects  the  enlargement  in  the  inguinal  region,  and 
the  hand  placed  upon  it  detects  the  succussion  as  the  child  cries. 

Direct  inguinal  hernia  is  that  form  in  which  the  bowel  is  forced 
through  the  abdominal  wall  immediately  above  the  external  ring, 
through  which  it  may  pass,  and  descend  into  the  scrotum,  as  in 
the  preceding  case. 

The  distinction  between  the  two  is  made  by  tracing  the  course 
of  the  protrusion.  In  the  first  there  is  the  oblique  distension  in 
the  course  of  the  inguinal  canal,  while  in  the  second  the  enlarge- 
ment ceases  immediately  above  Poupart's  ligament. 

Femoral  Hernia. — In  femoral  hernia,  the  intestine  forces 
its  way  under  Poupart's  ligament  through  the  femoral  ring,  and 
passing  up  through  the  saphenous  opening,  the  tumor  is  formed 
in  the  groin.  If  the  hernia  continues  to  increase,  the  bowel 
passes  upward  over  Poupart's  ligament,  assuming  very  nearly 
the  position  of  an  inguinal  hernia.  The  symptoms  are  the  same 
as  in  tlic  preceding  case,  and  it  will  be  diagnosed  by  a  careful 
examination. 


HEKNIA.  357 

Umbilical  Heenia. — Umbilical  hernia  is  of  more  frequent 
occurrence  in  the  child  than  in  the  adult.  This  is  owing  to  im- 
perfect closure  of  the  umbilicus,  after  the  detachment  of  the 
cord,  the  intestine  being  forced  through  this  natural  opening. 
It  varies  in  extent,  being  sometimes  but  slight,  not  larger  than 
a  good-sized  cherry,  but  in  other  cases  it  may  attain  the  size  of 
an  egg. 

The  diagnosis  is  easily  effected.  The  child  suffers  pain  and 
cries  severely ;  draws  its  feet  upwards,  and  contorts  its  body  as 
if  from  colic.  An  examination  of  the  abdomen  detects  the  seat 
aud  character  of  the  injury. 

Treatment. — A  hernia  being  diagnosed,  the  first  object  of 
treatment  is  to  return  it.  This  is  done  by  the  taxis — pressure 
being  made  on  the  bowel  in  the  direction  that  it  has  passed  down. 
This  pressure  should  be  gentle,  yet  continued,  the  whole  protru- 
sion being  well  supported  with  the  hand,  while  one  or  two  fingers 
are  engaged  in  dislodging  and  carrying  upwards  small  portions 
of  the  gut.  As  a  general  rule,  but  little  difficulty  will  be  ex- 
perienced in  replacement,  if  the  pressure  is  well  directed. 

If  the  taxis  fails  from  the  straining  or  resistance  of  the  child, 
it  should  be  brought  under  the  influence  of  chloroform,  when 
pressure  will  readily  reduce  it. 

After  reduction  is  effected,  we  will  have  to  select  an  appropri- 
ate apparatus  to  prevent  the  reproducement  of  the  hernia.  For 
infants  and  young  children,  I  prefer  a  well  fitted  bandage,  with 
a  soft  pad  large  enough  and  thick  enough  to  give  efficient  sup- 
port. I  think  in  the  majority  of  cases  a  radical  cure  will  follow 
its  use. 

In  children  over  two  years  of  age,  the  ordinary  spring  truss 
may  be  used.  The  hard  pad  is  decidedly  the  best,  and  should 
be  adapted  to  the  injury,  so  as  to  excite  the  part  and  promote 
adhesion. 


358  DISEASES  OP   CHILDREN. 


CHAPTEE    YIII. 
DISEASES   OF  THE   URINARY  APPARATUS. 


The  urinary  organs  of  the  child  do  not  suffer  so  frequently 
from  disease  as  do  those  in  the  adult ;  yet  when  such  diseases  do 
occur,  they  are  quite  severe  and  treated  with  difficulty.  The 
urinary  secretion  removes  materials  from  the  blood  which  are 
highly  noxious  when  retained,  and  diseases  impairing  this  func- 
tion are  always  followed  by  marked  constitutional  disturbance. 

ACUTE    NEPHRITIS. 

Acute  inflammation  of  the  kidneys  may  be  produced  by  cold, 
or  may  arise  from  other  causes  of  inflammation,  but  in  the  ma- 
jority of  cases  it  arises  during  the  progress  of  eruptive  fevers, 
especially  scarlatina;  and  is  doubtless  dependent  on  some  action 
of  the  fever  poison,  with  which  we  are  unacquainted.  It  is  pos- 
sible that  the  arrest  of  secretion  from  the  skin  in  these  cases 
throws  an  additional  amount  of  work  upon  the  kidneys,  from  the 
irritation  of  which  the  inflammation  arises. 

Symptoms. — Inflammation  of  the  kidneys  is  announced  by 
increased  excitement  of  the  nervous  system,  and  an  increase  in 
all  the  febrile  symptoms,  if  it  occurs  during  the  progress  of  an- 
other disease.  The  child  passes  urine  frequently,  but  in  very 
small  quantity,  and  seems  to  suffer  much  at  these  times.  In  some 
cases  the  urine  will  be  tinged  with  blood,  sufficient  to  discolor  the 
diaper.  The  pain  and  uneasiness  are  attended  with  contortions 
of  the  body,  flexure  of  the  limbs,  and  straining,  so  that  it  may 
be  easily  mistaken  for  colic. 

These  symptoms,  as  well  as  the  duration  of  the  period  of  excite- 
ment, will  vary  as  one  or  both  kidneys  are  involved  in  the  in- 
flammation. In  the  first  case  they  will  not  be  so  severe,  and 
may  last  two  or  three  days,  or  even  more ;  but  in  the  second  they 
will  not  last  longer  than  twenty-four  hours.  Occasionally  con- 
vulsions ensue  early  in  the  disease. 


ACUTE   NEPHRITIS.  359 

The  second  stage  of  an  inflammation  of  the  kidneys  is  that  ia 
which,  from  retention  of  urea,  the  nervous  system  is  depressed, 
and  coma  results.  A  very  short  time  is  necessary  for  this  change 
of  symptoms  (two  to  four  hours)  ;  the  nervous  irritation  passing 
off,  the  patient  becoming  dull,  drowsy  and  comatose;  this  gradu- 
ally deepening  until  the  patient  dies. 

In  the  first  stage  the  pulse  is  frequent  and  hard,  the  skin  dry 
and  harsh,  the  mouth  and  tongue  dry,  and  the  temperature  quite 
high.  In  the  second  stage  the  pulse  becomes  small,  its  frequency 
still  more  increased,  but  it  loses  its  hardness,  the  temperature  of 
the  surface  is  diminished,  and  the  extremities  become  cold,  yet 
the  thermometer  shows  a  higher  temperature  than  before. 

In  the  severe  cases  the  duration  of  the  disease  will  not  be  more 
than  from  two  to  four  days,  unless  the  patient  is  relieved.  Ia 
mild  cases  it  may  continue  a  week  or  more. 

Diagnosis. — The  increased  nervous  excitement  will  attract 
our  attention,  and  cause  us  to  make  a  very  close  examination. 
The  pain  that  the  child  suffers  is  undoubtedly  in  the  abdomen, 
and  would  be  mistaken  for  colic,  were  it  not  that  it  comes  on  in 
passing  urine,  and  is  very  closely  associated  with  this.  The 
scanty  urine,  tinged  with  blood,  passed  a  few  drops  at  a  time, 
and  with  straining  and  pain  as  named,  is  the  most  striking  diag- 
nostic feature. 

Prognosis. — The  prognosis  is  not  favorable  when  both  kid- 
neys are  involved,  unless  the  lesion  is  noticed  early  and  prompt 
treatment  is  adopted.  When  but  one  is  involved  we  expect  a 
favorable  termination.  The  prognosis  is  of  course  more  favora- 
ble in  the  stage  of  excitement,  than  in  that  of  depression  and 
coma. 

Treatment. — In  the  first  stage  of  the  disease  the  child  is  put 
upon  the  use  of  Veratrum  and  Gelseminum  in  full  doses,  the  ob- 
ject being  to  arrest  the  fever  and  inflammation  at  once.  I 
think  there  are  no  remedies  that  will  take  the  place  of  these,  at 
least  there  are  none  that  I  would  like  to  trust.  I  would  srive 
them  in  the  following  proportion  :  "E^  Tincture  of  Veratrum 
gtt.  v..  Tincture  of  Gelseminum  gtt.  x. ,  water,  ^W.  The  nurse 
is  directed  to  give  a  teaspoonful  every  hour,  until  she  observes 
an  abatement  of  the  fever,  then  reduce  the  dose  one-half  and 
continue. 


360  DISEASES  OP  CHILDREN. 

In  place  of  Gelseminum  we  sometimes  employ  Macrotys,  as 
there  is  muscular  pain  or  soreness,  or  Cannabis  Indica,  there  being 
irritation  of  the  urinary  passages,  even  to  the  meatus  urinarius. 
Bryonia  is  sometimes  a  good  remedy  if  there  is  marked  contrac- 
tion of  the  abdominal  muscles;  Belladonna  if  there  is  fullness  of 
the  abdomen  with  stupor  and  disposition  to  sleep,  or  if  there  has 
been  retrocession  of  an  eruption.  Eryngium  is  a  good  remedy  when 
there  is  a  constant  desire  to  pass  urine ;  Apocynum  when  the  eye- 
lids are  swollen  and  the  feet  oedematous,  or  the  slightest  evi- 
dence of  dropsy. 

Cathartics  are  absolutely  contra-indicated,  as  are  diuretics,  and 
diaphoretics  are  of  no  value  until  we  have  first  obtained  the  in- 
fluence of  the  remedies  named. 

As  a  local  application  I  like  the  influence  of  the  hot  hop 
fomentation  better  than  anything  else.  I  order  the  application 
across  the  loins,  the  child  lying  upon  the  abdomen,  but  when 
tired  in  this  position  it  is  placed  upon  its  back,  and  the  fomenta- 
tion applied  over  the  lower  part  of  the  abdomen. 

The  child  should  always  be  kept  in  bed,  between  blankets,  and 
the  action  of  the  skin  may  be  solicited  by  the  use  of  hot  bricks 
near  the  feet,  wrapped  in  wet  cloths. 

This  treatment  is  persisted  in  until  the  febrile  action  is  par- 
tially checked,  and  secretion  of  urine  is  increased,  the  patient 
meanwhile  being  allowed  as  much  fluid  as  desired,  unless  it 
causes  nausea.  As  soon  as  we  have  the  patient  fairly  under  the 
influence  of  the  sedatives,  we  commence  the  administration  of 
the  milder  vegetable  diuretics,  as  haircap  moss  or  mentha  viridis, 
and  continue  them  until  the  secretion  is  wholly  restored. 

In  the  second  stage  of  the  disease  the  patient  is  suffering  from 
ursemic  poisoning,  and  the  treatment  will  be  wholly  different.  We 
give  at  once  a  brisk  cathartic,  as  of  jalap  and  bitartrate  of  potash, 
and  if  the  case  is  one  of  emergency,  we  may  aid  its  action  by  a 
cathartic  enema. 

Dry  cups  are  applied  to  the  neck  and^over  the  loins,  and  a  hot 
stimulant  application  over  the  kidneys  follows  their  use.  Stim- 
ulants and  heat  are  also  applied  to  the  extremities. 

The  internal  remedy  that  I  rely  upon  with  most  confidence  is 
Belladonna,  which  may  be  given  in  the  following  proportions  : 
I^  Tincture  of  Belladonna  gtt.  v.,  Tincture  of  Aconite  git.  v., 
water  5iv. ;  a  toaspoouful  every  hour.  If  the  reader  can  not 
make  up  his  mind  to  the  use  of  such  small  doses  in  such  a  grave 


CHRONIC  NEPHRITIS.  361 

affection,  I  would  advise  in  its  place  a  prompt  and  very  thorough 
emetic,  followed  by  the  cathartic  as  first  named. 

In  the  use  of  diuretics  we  will  have  to  be  very  careful  as  the 
patient  convalesces,  for  the  kidneys  are  in  a  very  irritable  condi- 
tion, and  a  slight  irritant  is  sufficient  to  arrest  the  flow  of  urine. 
It  is  fortunate  that  the  tincture  of  muriate  of  iron,  in  quite  small 
doses,  is  a  good  tonic  to  the  kidneys,  as  it  is  the  restorative  we 
most  frequently  employ. 

CHRONIC  NEPHRITIS. 

Chronic  nephritis  is  never  met  with  during  the  first  year,  is 
very  rare  during  the  second,  but  is  occasionally  met  with  from 
this  up  to  the  sixth  year.  After  this  time  it  is  hardly  ever  seen 
until  the  person  has  reached  middle  life.  It  is  a  very  insidious 
disease,  coming  on  slowly,  and  presents  so  few  prominent  symp- 
toms that  in  many  cases  it  is  not  detected. 

Causes. — The  causes  of  chronic  nephritis  are  very  obscure. 
It  may  arise  from  cold,  from  irritant  diuretics,  but  probably  is 
most  frequently  the  result  of  some  morbid  condition  of  the  blood, 
or  change  in  the  process  of  retrograde  metamorphosis.  We  know 
the  irritant  effect  that  the  presence  of  the  urates,  triple  phosphates 
and  oxalates  have  on  the  bladder,  and  we  can  well  imagine  that 
their  excretion  by  the  kidneys  may  set  up  a  slow  process  of  in- 
flammation in  these  organs. 

Pathology. — The  inflammation  may  be  confined  to  one,  or 
may  affect  both  organs,  or  it  may  involve  but  the  cortical  struc- 
ture of  the  kidney,  the  tubular  remaining  comparatively  free. 

Post-mortem  examination  shows  the  kidneys  enlarged,  with 
evidences  of  enfeebled  circulation.  The  structure  is  soflened  and 
friable,  and  the  capsule  readily  detached.  In  some  cases  there 
is  a  free  <leposit  of  a  white  amorphous  material.  In  others  the 
inflammation  has  progressed  to  suppuration,  and  more  or  less  of 
the  structure  has  been  destroyed  by  it. 

Symptoms. — The  child  has  lost  flesh  and  strength,  in  a  marked 
degree  ;  its  appetite  is  impaired,  digestion  feeble,  the  bowels  irreg- 
ular and  the  skin  dry  and  harsh.  Irritability  and  restlessness 
is  a  marked  feature,  and  is  sometimes  develo|)ed  to  that  extent 
that  the  child  becomes  a  burden  to  itself  and  all  around  it. 


362  DISEASES   OF    CHILDIJEN.  ' 

If  old  enough  to  locate  its  sufferings  it  will  complain  of  pain  in 
the  back  and  across  the  lower  part  of  the  abdomen.  Occasion- 
ally it  experiences  uneasiness  before  urinating,  and  sometimes 
after  its  discharge.  Frequently,  however,  no  complaint  of  this 
kind  is  made,  and  though  the  child  undoubtedly  suffers  uneasi- 
ness and  pain,  it  is  of  such  a  fugitive  character  that  he  can  not 
locate  it. 

These  symptoms  are  constant,  and  gradually  increase,  but  in 
addition  there  are  exacerbations  in  the  disease,  coming  on  at  in- 
tervals of  two  or  three  weeks.  At  these  times  the  patient  suffers 
from  fever,  the  skin  is  dry  and  hot,  the  urine  very  scanty,  the 
bowels  constipated,  while  the  face  has  a  pinched  and  anxious  ex- 
pression. It  is  evident  at  these  times  that  the  child  suffers  from 
pain  in  the  back ;  and  frequently  the  lameness  is  quite  marked. 

Thus  the  disease  progresses,  until  finally  the  periodic  exacer- 
bation of  the  inflammation  is  much  worse.  The  fever  is  active, 
with  great  excitation  of  the  nervous  system,  occasionally  with 
convulsions.  The  urinary  secretion  being  arrested,  the  symp- 
toms ofurcemia  are  rapidly  developed,  and  within  twenty-four 
hours  the  patient  is  comatose,  and  by  another  day  it  terminates 
fatally. 

Diagnosis. — The  diagnosis  is  principally  made  by  exclusion. 
The  examination  is  made  with  reference  to  disease  of  special 
parts,  as  of  the  brain,  lungs,  digestive  apparatus,  etc.  One  after 
another  being  excluded,  we  finally  trace  the  diseased  action  to 
the  kidneys,  and  the  symptoms  given  above  will  be  found  suffi- 
cient to  designate  the  character  of  the  disease. 

Prognosis. — The  prognosis  is  favorable  in  the  early  stage  of 
the  disease;  but  when  it  has  continued  for  some  months,  having 
lost  flesh  to  a  great  degree,  with  frequent  pulse,  harsh  dry  skin, 
scanty  high-colored  urine,  great  irritability  of  the  nervous  system, 
with  a  pinched  and  anxious  expression  of  countenance,  the  prog- 
nosis is  doubtful. 

Treatment. — The  treatment  of  this  case  is  one  of  much  diffi- 
culty, and  will  have  to  be  varied  from  that  we  would  use  in  the 
adult.  As  a  general  rule,  I  should  give  but  few  medicines,  in- 
deed experience  will  teach  that  the  stomach  will  not  tolerate 
much,  and  that  all  irritants  are  injurious. 


ALBUMINURIA.  363 

Small  doses  of  Aconite  with  Gelseminum,  Rhus,  Bryonia, 
Apocynuin,  Eryngiiini,  Cannabis  Indica,  or  Agrinionia,  as  indi- 
cated, will  serve  the  purpose  well.  Apocynuni  should  be  espe- 
cially noted  as  the  remedy  if  there  is  the  slightest  evidence  of 
oedema.  Agrimonia  is  indicated  by  the  pain  which  sometimes 
extends  up  into  the  hypochondria.  If  the  ciiild  is  nervous  and 
cries  at  every  little  thing  with  sobbing,  small  doses  of  Pulsatilla 
may  be  alternated  with  the  other  remedies. 

The  child  may  have  a  hot  salt-water  bath  every  day,  being 
rubbed  with  dry  flannels  afterward  and  clothed  warm.  Or,  in 
place  of  this,  we  may  use  fatty  inunction,  rubbing  the  surface 
thoroughly.  Inunction  with  quinine  answers  an  excellent  pur- 
pose in  some  cases,  especially  those  in  which  there  is  a  malarial 
influence. 

The  best  Icoal  application  for  the  child  is  the  vinegar  pack, 
applied  upon  going  to  bed.  A  flannel  cloth,  six  inches  wide,  is 
wrung  out  of  tepid  vinegar,  and  applied  around  the  body  at  the 
loins,  and  this  is  again  covered  by  a  dry  strip;  it  is  removed  on 
getting  up,  and  the  part  thoroughly  rubbed  with  flannel. 

As  the  severer  symptoms  pass  away,  the  patient  may  have 
some  of  the  tonic  and  astringent  diuretics,  if  thought  best,  or  it 
may  be  continued  upon  the  remedies  already  named,  at  less  fre- 
quent intervals.  The  compound  syrlip  of  the  hypophosphites, 
some  of  the  preparations  of  malt,  occasionally  iron,  Collinsonia, 
Hydrangea,  or  Eryngium,  or  the  quinine  inunction,  may  be  con- 
tinued to  complete  recovery. 

ALBUMINURIA. 

While  albuminuria  in  the  child  is  most  frequently  the  sequel 
of  the  eruptive  fevers,  it  is  occasionally  seen  from  other  causes. 
It  is  not  dependent,  however,  on  granular  degeneration,  or 
Bright's  disease,  in  either  of  these  cases,  and  is,  therefore,  a  much 
less  grave  affection. 

Pathology. — It  has  been  supposed  that  the  albuminuria  fol- 
lowing the  eruptive  fevers  was  dependent  upon  irritation,  or  a 
low  grade  of  inflammation  of  the  kidneys.  While  this  may  be 
the  cause,  to  a  certain  extent,  we  have  reason  to  believe  that  the 
changes  effected  in  the  blood  by  the  febrile  poison  is  an  im- 
portant element  of  the  disease.         , 


364  DISEASES  OP  CHILDREN. 

Post-mortem  examination  shows  tlie  kidneys  swollen,  the 
glomeruli  congested,  and  the  tubuli  uriniferi  more  or  less  loaded 
with  albuminoid  matter.  Casts  from  the  tubules  may  be  de- 
tected in  the  urine  during  the  progress  of  the  disease. 

Symptoms. — Occurring  almost  always  after  the  eruptive  fevers, 
on  exposure  to  cold,  by  which  the  surface  is  suddenly  chilled,  it 
commences  generally  with  a  well-defined  chill;  symptomatic 
fever  follows,  the  pulse  being  hard  and  frequent,  the  skin  hot, 
dry,  and  constricted,  the  tongue  coated  white,  the  mouth  dry, 
frequently  nausea  and  vomiting,  bowels  constipated,  pain  in  the 
back,  and  marked  restlessness  and  nervous  irritation.  With 
these  symptoms  the  patient  complains  of  a  sense  of  weight  and 
constriction  in  the  regi'on  of  the  kidneys,  never,  as  is  said,  ex- 
tending to  or  causing  retraction  of  the  testicles.  The  pain  may 
be  confined  to  one  side,  but  one  kidney  being  affected,  or  it  may 
be  equally  in  both  sides. 

With  the  occurrence  of  these  symptoms  the  urine  becomes 
scant,  almost  suppressed,  and  highly  albuminous,  of  a  reddish 
color,  and  occasionally  bloody.  Its  specific  gravity  is  almost 
always  abov^e  that  of  healthy  urine,  and  it  gives  an  acid  reaction. 
When  allowed  to  rest,  it  deposits  a  filamentous  substance,  and 
when  examined  with  the  microscope  it  will  present  blood-glo- 
bules, mucus,  epithelium,  and  in  some  cases  complete  casts  of  the 
urinary  tubules.  A  dirty-white  sediment  is  frequently  depos- 
ited from  the  urine,  not  unlike  mucus,  and  easily  diffused  by 
agitation.  The  urine  is  frequently  passed  with  difficulty,  and 
sometimes  with  pain,  the  calls  to  urinate  being' frequent  and  dis- 
tressing. 

In  the  course'of  the  second  or  third  day  dropsical  symptoms 
make  their  appearance,  most  frequently  as  anasarca  of  the  eye- 
lids, face,  and  at  last  of  the  whole  body.  The  skin  at  this  time 
is  hot,  and  does  not  pit  except  upon  firm  pressure.  If  properly 
treated,  in  a  majority  of  cases,  we  find  that  the  symptoms  are 
much  mitigated  in  the  first  three  or  four  days,  and  the  disease 
terminates  in  recovery  by  the  twelfth  to  the  fifteenth  day.  In 
other  cases  coma  comes  on  by  the  second,  third,  or  fourth  day, 
and  the  disease  terminates  fatally  within  the  first  week.  Occa- 
sionally convulsions  appear,  and  continue  until  the  patient  is 
exhausted.  In  other  cases  the  disease  seems  to  give  way  slowly, 
until  it  reaches  the  chronic  stage,  in  which  it  continues. 


DIABETES.  365 

Treatment. — If  the  temperature  is  above  the  normal  stan- 
dard and  the  pulse  is  too  frequent,  we  give  Aconite  with  Apocy- 
num,  (gtt.  iij.,  gtt.  v.  to  gtt.  x.,  water  5iv.)  In  some  cases,  fol- 
lowing the  eruptive  fevers,  there  has  been  something  omitted 
from  the  treatment  of  the  cases,  and  we  endeavor  to  find  it.  It 
is  possibly  Belladonna,  Rhus,  Apis,  Phytolacca,  or  Macrotys,  but 
whatever  it  is,  it  should  now  be  given  if  the  indications  still 
persist. 

In  some  cases  the  hydragogue  cathartic,  like  jalap  with  bitar- 
trate  of  potash,  is  employed,  to  increase  secretion  by  way  of  the 
bowels,  and  remove  dropsical  accumulations,  but  I  prefer  the 
more  direct  remedies,  Apocynum  and  Aralia  Hispida. 

If  the  dropsy  is  not  reached  by  these  remedies,  we  will  some- 
times find  the  small  dose  of  sulphate  of  manganese  a  good  rem- 
edy. It  may  be  given  in  the  following  proportion :  ^i  Sulphate 
of  manganese  gr.  v.,  white  sugar  5j-;  make  twenty  powders,  and 
give  one  every  three  hours  until  it  acts  upon  the  bowels. 

The  hot  foot-bath  may  be  used,  and  dry  cups,  followed  by  hot 
fomentations,  applied  to  the  loins.  If  the  case  seems  to  be  ur- 
gent, we  may  use  the  general  hot-bath  with  advantage,  continued 
for  one  or  two  hours,  the  surface  being  rubbed  dry,  and  the  child 
clothed  or  wrapped  in  flannel. 

In  some  cases  quinine  inunction  answers  an  excellent  purpose, 
but  sometimes  the  fatty  matter  seems  to  close  the  skin,  and  we 
are  obliged  to  have  the  child  thoroughly  washed  with  soap  and 
water  to  remove  it.  In  other  cases  the  inactivity  of  the  skin  is 
relieved  by  a  sponge  bath  of  hydrochlorate  of  ammonia  and 
water. 

DIABETES. 

I  have  never  seen  but  one  case  of  diabetes  in  children  giving 
the  evidence  of  sugar  on  analysis,  and  this  was  in  quite  small 
quantify,  and  for  a  short  time  ;  neither  do  I  recollect  seeing  any 
such  cases  recorded.  Diabetes  insipidus,  on  the  contrary,  is  met 
with  quite  as  frequently  in  childhood  as  in  the  adult,  and  is  some 
times  very  persistent. 

Causes. — The  causes  giving  rise  to  this  increased  flow  of  urine 
are  very  obscure.  In  some  cases  the  exciting  cause  seems  to  be 
cold,  but  more  frequently  it  will  be  found  to  be  dependent  npon, 
or  at  least  associated  with  some  disease  of  the  nervous  centers. 


366  DISEASES   OF   CHILDREN. 

Pathology. — I  think,  in  all  of  these  cases,  there  is  an  impair- 
ment of  circulation,  with  tendency  to  congestion.  The  nervous 
system  suffers  first,  and  the  enfeebled  innervation  seems  to  be  one 
cause  of  the  lesion  of  the  kidneys.  The  condition  of  the  kid- 
neys seems  to  be  one  of  atony  rather  than  excitation — one  which 
permits  the  water  of  the  blood  to  filter  oif,  rather  than  increased 
activity  of  secretion.  Indeed,  in  some  cases,  the  patient  suffers 
first  the  nervous  irritation  from  retained  urea,  and  afterward 
from  ursemic  coma.  Occasionally  there  is  the  same  profluvia 
from  the  bowels,  but  in  less  degree. 

Symptoms. — It  will  have  been  noticed  that  the  child  has  lost 
flesh  rapidly  for  two  or  three  weeks,  or  may  be,  for  as  many 
months,  and  that  it  is  becoming  quite  feeble ;  yet  it  has  a  pretty 
good  appetite,  and  digestion  is  well  performed,  and  the  child  does 
not  complain  of  any  particular  suffering.  If  associated  with 
diarrhoea,  the  loss  of  flesh  and  strength  will  be  attributed  to  this. 
When  we  examine  the  patient,  we  find  the  pulse  feeble,  small, 
and  sofl,  and  somewhat  increased  in  frequency;  the  surface  is 
pale,  cool,  and  wanting  in  tone,  and  the  child  suffers  from  cold 
feet  and  feeble  circulation.  The  tongue  and  mucous  membranes 
are  pallid,  but  the  tongue  is  not  coated.  Usually  there  are  two, 
three,  or  four  fluid  movements  from  the  bowels  daily,  but  they 
are  not  kirge  or  unhealthy. 

Upon  close  inquiry,  we  will  learn  that  the  child  passes  water 
frequently  at  night,  and  the  bedding  is  veiy  wet,  and  when  the 
mother's  attention  is  called  to  it,  she  will  notice  the  frequent 
passage  of  large  quantities  of  clear  urine.  If  we  examine  a 
portion  of  the  urine  we  will  find  it  limpid,  very  light-colored, 
and  of  low  specific  gravity,  frequently  not  more  than  1008.  I 
have  seen  cases,  in  which  the  child  would  urinate  on  an  average 
every  fifteen  minutes  during  the  day,  and  every  half  hour  at 
night. 

In  the  severer  cases  the  marasmus  is  as  great  as  in  the  diabetes 
mellitus  of  the  adult.  In  such  cases  the  irritation  of  the  nervous 
system  is  extreme,  and  the  child  suffers  intensely  from  nervous 
excitement.  In  some  cases  it  seems  almost  impossible  for  it  to 
obtain  sleep.  Continuing  on  in  this  way  for  a  short  time,  this 
is  replaced  by  coma,  and  a  few  hours  will  terminate  its  life. 

Diagnosis. — The  diagnosis  of  diabetes  of  the  child  will  be 
easily  made,  if  our  attention  is  directed  to  the  kidneys  as  the  seat 


DIABETES.  367 

of  disease.  This  is  the  advantage  of  forming  a  habit  to  correct 
the  diagnosis  of  every  case  by  exclusion;  as  each  organ  is  thus 
passed  under  review,  it  is  almost  impossible  to  fall  into  serious 
error.  The  frequent  and  abundant  discharge  of  urine  may  have 
escaped  notice  until  attention  is  drawn  to  it,  or  the  mother  may 
have  considered  it  an  unimportant  circumstance. 

Prognosis. — The  prognosis  is  favorable  in  the  majority  of 
cases,  as  the  disease  yields  readily  to  remedies.  When  it  has 
continued  for  a  considerable  time,  the  child  being  wasted  almost 
to  a  skeleton,  the  nervous  system  being  very  irritable,  the  prog- 
nosis is  unfavorable. 

Treatment. — In  the  milder  cases,  the  treatment  is  very  sim- 
ple and  direct.  The  child  is  put  upon  the  use  of — I^  Tincture 
of  Belladonna  gtt.  v.,  water  5iv.;  a  teaspoonful  every  two  hours. 
To  restore  the  action  of  the  skin,  and  at  the  same  time,  get  its 
action  as  a  tonic,  I  employ  the  quinine  inunction  once  daily. 
When  there  is  atony  of  the  digestive  apparatus,  and  torpor  of  the 
liver,  minute  doses  of  podophyllin  may  be  given.  The  following 
combination  will  answer  well:  ^  Podophyllin  gr.  j.,  Hydrastine 
gr.  v.,  white  sugar  gr.  xx. ;  tritutate  thoroughly  and  divide  in 
twenty  parts ;  one  may  be  given  in  the  morning  and  one  at 
night. 

In  some  cases  we  may  alternate  the  Belladonna  with  Hama- 
melis  (Pond's  extract),  in  doses  of  ten  drops,  giving  each  every 
four  hours;  and  when  diarrhcea  accompanies  it,  this  may  be  con- 
trolled with  Ipecac. 

As  the  disease  is  brought  under  the  control  of  remedies,  we 
may  alternate  them  with  the  Collinsonia,  tincture  of  phosphorus, 
Rhus  Aromatica,  and  the  tincture  of  muriate  of  iron,  as  a  restor- 
ative. But  if  the  patient  gets  along  well,  we  will,  in  the  major- 
ity of  cases,  find  no  cause  for  change. 

ISCHURIA. 

Ischuria,  or  arrested  discharge  of  urine,  is  divided  into  two 
varieties — ischuria  renalis,  suppression  of  urine,  and  ischuria 
vesicnlis,  retention  of  urine.  Both  of  these  should  be  regarded  as 
but  symptoms,  as  they  may  arise  from  various  and  widely  differ- 
ent causes. 


368  DISEASES  OF  CHILDREN. 

Suppression  of  Urine. — Suppression  of  urine  may  be  the  re- 
sult of  an  active  inflammation  of  the  kidneys,  as  we  have  already 
seen.  But  the  cases  that  will  come  under  our  notice  most  fre- 
quently, depend  upon  exhaustion  or  enfeebled  innt^rvation  of  the 
kidney,  or  from  congestion.  It  occurs  most  frequently  during 
the  progress  of  acute  disease,  especially  in  such  as  are  attended 
with  serious  blood-poisoning. 

Symptoms. — The  symptoms  of  suppression  of  urine  vary  in 
different  cases.  Where  the  suppression  is  partial,  as  is  generally 
the  case,  we  find  the  first  evidence  in  great  excitation  of  the 
nervous  system,  and  an  increase  of  the  febrile  symptoms.  Not 
unfrequently,  we  will  find  the  desire  to  pass  urine  increased,  and 
the  frequency  of  the  effort,  but  small  quantities  passing,  will  first 
attract  the  attention. 

As  it  continues,  the  symptoms  of  the  ursemic  coma  begin  to  be 
developed,  the  child  is  dull,  has  a  tendency  to  sleep  with  its  eyes 
partly  open,  and  starts  frequently  from  its  sleep  as  if  alarmed. 
Occasionally  convulsions  precede  the  coma,  which  seem  to  be 
dependent  upon  it? 

Nausea  and  vomiting  occasionally  occur  in  the  early  part  of 
the  disease,  and  the  irritability  of  the  stomach  is  one  of  its  most 
troublesome  features.  From  the  commencement  of  coma,  we  find 
it  becoming  deeper  as  time  passes,  until  at  last  it  is  impossible  to 
arouse  the  patient.  The  pulse  is  feeble  and  irregular,  the  ex- 
tremities cold,  the  features  contracted  and  pinched,  with  occa- 
sionally more  or  less  convulsive  movement,  until  death  ensues. 

Retention  of  Urine. — Retention  of  urine  is  most  frequently 
due  to  paralysis  of  the  bladder,  though  it  may  be  produced  by 
irritation  of  and  contraction  of  the  neck  of  the  bladder  or 
urethra,  or  in  some  rare  cases,  it  is  dependent  upon  the  presence 
of  a  calculus. 

Retention  from  exhaustion  of  the  muscular  coat  is  of  common 
occurrence  in  low  forms  of  disease,  and  is  sometimes  a  source  of 
much  trouble.  Retention  from  irritation  of  the  urethra  is 
attended  with  much  pain,  and  a  frequent  desire  to  pass  water. 

Symptoms. — In  retention  of  urine  occurring  during  the  pro- 
gress of  low  ft)rms  of  fever  and  imflammation,  it  will  be  noticed 
that  the  prostration   is   much  greater,  and  the  symptoms  more 


ISCHURIA.  369 

grave,  than  would  have  been  anticipated  in  the  ordinary  pro- 
gress of  the  disease.  Frequently  the  attention  is  drawn  to  the 
difficulty  by  the  marked  uneasiness  of  the  child,  and  the  move- 
ment of  the  hands  to  the  region  of  the  bladder. 

In  retention  from  contraction  of  the  neck  of  the  bladder  or 
urethra,  there  is  the  evident  desire  to  pass  urine,  attended  with 
straining  and  pain,  but  the  want  of  power  to  overcome  the  ob- 
struction. 

Diagnosis. — Having  learned  that  the  urine  has  not  been 
passed,  we  have  to  determine  whether  it  is  a  suppression  or  re- 
tention. This  may  be  determined  in  many  cases,  by  the  symp- 
toms above  described,  or  by  an  examination  of  the  bladder  with 
the  hand.  If  this  is  not  satisfactory,  a  catheter  may  be  intro- 
duced into  the  bladder.  This,  however,  is  attended  with  diffi- 
culty, and  may  generally  be  dispensed  with. 

Treatment. — In  the  treatment  of  suppression  of  urine  in  the 
child,  I  rely  more  upon  the  use  of  hot  fomentations  across  the 
loins,  than  on  any  other  means.  They  should  be  assiduously 
employed,  and  continued  until  the  desired  result  is  produced.       ^ 

If  the  patient  has  fever,  Tinct.  Veratrum  gtt.  iij.,  Tinct.  Gel- 
seminum  gtt.  x.,  water  o'v.,  a  teaspoonful  every  hour,  will  be 
good  treatment.  If  the  face  is  pinched  and  the  patient  is  rest- 
less, starting  in  sleep,  Rhus  may  be  given  with  Aconite.  If  the 
patient  is  dull  and  wants  to  sleep  most  of  the  time.  Belladonna 
will  be  suggested.  Apocynum  answers  an  excellent  purpose,  if 
there  is  a  puffy  condition  of  the  eye-lids,  or  swollen  feet. 

To  relieve  the  system  from  the  symptoms  of  ursemic  poisoning, 
a  cathartic  may  sometimes  be  given,  if  there  are  no  circumstances 
to  contra-indicate  it ;  jalap  and  bitartrate  of  potash  will  answer 
this  purpose  very  well. 

As  soon  as  urine  commences  to  pass  in  small  quantities,  diure- 
tics may  be  administered,  the  remedy  being  selected  to  meet  the 
condition  of  the  patient,  being  demulcent,  stimulant,  or  tonic,  as 
the  case  may  require. 

In  some  cases,  dry  cups  may  precede  the  use  of  the  hot 
fomentations,  and  will  be  found  of  much  service. 

In  the  treatment  of  retention  of  urine  in  children,  I  prefer  the 

use  of  santonine  to  any  other  remedy  I  have  employed.     I  have 

used  it  in  doses  of  from  one-fourth  to  one  grain,   triturated  with 

sugar,  repeated  every  two  hours.     This  may  be  assisted  by  hot 

24 


370  DISEASES   OP  CHILDREN. 

fomentations  applied  over  the  bladder  and  genitals,  or  in  some 
cases  by  a  hot  sitz  bath. 

The  use  of  diuretics  is  contra-indicated  in  this  case,  as  they 
rather  diminish  than  increase  the  power  of  the  bladder  to  evacu- 
ate urine,  while  they  certainly  increase  the  distension. 

When  the  retention  is  dependent  upon  stricture  of  the  urethra, 
or  contraction  from  irritation,  we  will  obtain  the  best  results 
from  an  enema  of  equal  parts  of  Lobelia  and  Gelseminum  5ss  to 
water  .5j. 

ENURESIS. 

Incontinence  of  urine  is  most  commonly  a  disease  of  child- 
hood, though  we  occasionally  meet  with  it  in  the  adult,  but 
usually  as  the  result  of  injury,  or  from  disease.  In  the  child  it 
varies  from  the  slight  form  of  nocturnal  incontinence,  to  the 
severer  cases  in  wiiich  the  patient  is  wholly  unable  to  retain  the 
urine,  and  it  flows  away  all  the  time. 

Causes. — The  causes  of  incontinence  are  somewhat  obscure. 
In  some  of  tiie  milder  cases  it  seems  to  be  a  habit  more  than  a 
disease.  The  severer  cases  follow  the  eruptive  fevers,  diseases  of 
the  nervous  system,  and  occasionally  diseases  of  the  urinary  ap- 
paratus. 

Pathology. — In  some  cases  the  incontinence  is  dependent 
upon  an  irritable  condition  of  the  mucous  membrane  of  the 
bladder,  slight  distension  of  the  viscus  giving  rise  to  involuntary 
muscular  contractions  and  expulsion  of  urine.  In  other  cases 
the  muscular  fiber  is  in  an  irritable  condition,  and  contracts  from 
slight  excitement.  In  other  cases,  and  by  far  the  most  numerous 
ones,  the  lesion  is  of  the  nervous  system.  In  one  it  is  of  the 
spinal  system,  an  atonic  or  feeble  condition,  and  as  the  result  of 
this,  tliere  is  imperfect  contraction  of  the  circular  libers  at  the 
neck  of  the  bladder,  and  the  first  portion  of  the  urethra,  which 
serves  the  purpose  of  a  sphincter.  In  the  other  it  depends  upon 
irritation  of  the  lumbar  spine,  with  involuntary  contraction  of 
the  bladder  from  the  disordered  innervation. 

Symptoms. — The  simplest  form  of  the  disease  is  that  in  which 
the  child  loets  the  bed.  Frequently,  in  these  cases,  the  child 
drinks  freely  in  the  evening,  and  the  bladder  being  distended  at 


ENURESIS.  371 

night,  the  urine  is  passed  unconsciously,  or  under  the  influence 
of  a  dream.  This  may  continue  to  the  age  of  puberty,  or  even 
longer,  becoming  a  source  of  very  great  annoyance  and  mortifi- 
cation. 

In  other  cases  there  is  not  only  the  nocturnal  incontinence, 
but  there  is  a  frequent  desire  to  evacuate  the  bladder  through 
the  day,  and  if  not  promptly  attended  to,  involuntary  passage  of 
urine  occurs. 

Then  there  is  the  severe  form  of  the  disease,  in  which  the 
person  has  no  command  over  the  passage  of  urine,  but  it  dribbles 
away  continually,  keeping  the  clothes  soiled,  and  making  it  quite 
impossible  to  keep  the  child  free  from  a  disgusting  urinous  odor, 
irritating  the  surface  about  the  parts,  and  requiring  much  care 
to  prevent  its  suffering  from  cutaneous  irritation. 

Treatment. — In  the  simpler  forms  of  nocturnal  incontinence, 
it  is  frequently  sufficient  to  prevent  the  child's  drinking  in  the 
evening,  see  that  it  passes  urine  before  going  to  bed,  and  have  it 
waked  once  in  the  night  for  the  same  purpose.  What  we  want 
is  to  break  up  the  habit  of  involuntary  passage,  and  this  may  be 
done  in  the  majority  of  cases  in  this  way. 

In  this,  and  other  forms  of  the  disease,  when  there  is  no  special 
lesion,  I  rely  upon  the  Belladonna  as  a  specific.  I  usually  pre- 
scribe it  in  the  following  proportions .  I|<  Tincture  of  Bella- 
donna gtt.  X.,  water  .5iv.;  a  teaspoonful  three  times  a  day.  In  se- 
vere cases,  those  dependent  upon  atony  of  the  spinal  cord,  or 
consequent  want  of  contraction  of  the  sphincter  fibres,  the  Bella- 
donna is  our  best  remedy,  and  will  give  relief  when  the  person 
has  been  supposed  incurable.  Ergot  has  a  very  similar  influ- 
ence, and  may  sometimes  be  alternated  with  it.  I  would  use  it 
in  the  proportion  of — I^  Tincture  of  Ergot  gtt.  xx.,  water  Si  v. ; 
a  teas[)oonfnl  four  times  a  day. 

The  Rhus  Aromatica  has  been  highly  recomended  in  these 
cases,  and  may  be  tried,  though  thus  far  I  have  not  seen  the 
marked  results  that  have  been  described.  In  feeble  children  the 
syrup  of  iodide  of  iron  has  been  given  with  advantage  in  doses 
of  five  or  ten  drops  three  times  a  day. 

Irritability  of  the  bladdder  should  be  treated  by  the  use  of 
Agrimonia,  Hydrangea,  or  Collinsonia,  combined  with  a  tonic  and 
restorative  treatment,  as  it  is  usually  associated  with  impaired 
health.     A  Belladonna  plaster  applied  over  the  bladder  will  give 


372  DISEASES  OF    CHIT^DREN. 

present  relief,  but  its  continued  use  will  sometimes  produce  un- 
pleasant symptoms.  Frictions  over  the  bladder  with  the  lini- 
ment of  Stillingia  will  answer  a  better  purpose. 

In  those  rare  cases  in  which  the  incontinence  is  epileptic  in  its 
character,  I  would  advise  the  bromide  of  ammonium  alternated 
with  Belladonna.  , 

URINARY    CALCULI. 

Stone  in  the  bladder  is  met  with  even  during  the  first  year  of 
life,  and  from  this  up  to  adult  age.  It  is  not  of  as  frequent 
occurrence  in  the  child  as  in  the  adult,  yet  it  is  met  with  more 
frequently  than  many  suppose.  There  is  no  doubt  but  that 
many  children  suffer  for  months,  and  finally  lose  their  lives, 
without  the  detection  of  the  lesion. 

Previous  to  the  last  quarter  of  a  century  we  find  but  few  cases 
of  stone  in  the  bladder  of  children  recorded,  and  the  cases  of 
cutting  for  stone  in  children  under  six  could  be  counted 
upon  the  fingers.  In  the  last  few  years  a  large  number  of  cases 
have  been  reported,  with  successful  operations  for  their  relief. 
One  surgeon  alone  reports  some  thirty  cases  in  ten  years.  We 
must,  therefore,  conclude  that  the  disease  was  not  recognized,  as 
it  is  not  probably  of  more  frequent  occurrence  now  than  in  the 
centuries  past.  Knowing  these  facts,  we  will  not  allow  ourselves 
to  make  the  same  error  in  diagnosis. 

If  stone  in  the  bladder  in  the  child  was  incurable,  this  error 
in  diagnosis  would  make  less  diff^erence;  but  the  experience  of 
some  of  the  most  skillful  surgeons  shows  that  the  operation  for 
its  removal  is  much  more  successful  than  in  the  adult  or  aged. 

Pathology. — Urinary  calculi  may  result  from  lesions  of  di- 
gestion, but  mostly  from  lesions  in  the  waste  of  tissue  and  retro- 
grade metamorphosis.  All  are  composed  of  the  normal  elements 
of  tissue,  except  in  those  rare  cases  in  which  the  material  is 
furnished  by  maldigestion.  The  urinary  organs  do  not  seem  at 
all  at  fault,  indeed  they  perform  the  additional  function  of  re- 
moving a  material  from  the  blood  which  would  prove  injurious 
there. 

The  calculous  formations  in  childhood  arc  principally  of  tliree 
kinds — uric  acid  and  urates,  oxalates,  and  pJwsphates.  These 
may  be  deposited  in  the  form  of  minute  crystals,  being  washed 


URINAEY  CALCULI.  373 

from  the  bladder  by  the  flow  of  urine,  giving  rise  to  no  lesion 
but  irritation  of  the  bladder  and  urethra;  or  they  may  accumu- 
late and  coalesce  to  form  those  masses  of  variable  size,  which  we 
know  as  calculi. 

The  uric  or  lithic  calculus  is  of  a  brownish  mahogany  color, 
oval  or  flattened  in  form,  and  finely  tuberculated  or  smooth, 
tliough  not  polished.  It  is  perfectly  dissolved  in  caustic  potash, 
and  disappears  with  effervescence  in  hot  nitric  acid,  the  solution 
affording,  when  evaporated  to  dryness,  a  bright  carmine  residue. 
It  becomes  black  and  is  gradually  consumed  before  the  blow-pipe, 
leaving  a  minute  quantity  of  white  alkaline  ashes. 

Oxalic  calculi  are  generally  of  a  dark  brown  color,  rough  and 
tuberculated,  hard,  compact  and  imperfectly  laminated.  It  is 
insoluble  in  the  alkalies,  dissolves  slowly  in  nitric  and  hydro- 
chloric acids,  if  previously  well  broken  up,  and  under  the  blow- 
pil)e,  expands  and  effloresces  into  a  white  powder. 

Phosphaiic  calculi  are  of  a  lighter  color,  less  clear  and  friable. 
Phosphate  of  lime  more  frequently  forms  layers  with  other  mat- 
ter;  when  it  occurs  alone,  they  are  usually  small,  of  a  pale  brown 
color,  of  a  loosely  laminated  structure,  not  fusible  with  the  blow- 
pipe, but  readily  soluble  in  hydrochloric  acid  with  effervescence. 
The  amoniaco-magnesian  calculus  is  of  a  white  color  and  friable, 
looking  a  good  deal  like  a  mass  of  chalk.  It  exhales  an  ammo- 
niacal  odor  before  the  blow- pipe,  is  not  affected  with  caustic 
potash,  but  is  easily  dissolved  in  dilute  acids.  There  is  a  form 
ofphosphatic  calculi  that  is  fusible.  It  is  white,  extremely 
brittle,  easily  separated  into  layers,  and  leaves  a  white  dust  on 
the  fingers.  It  is  not  affected  by  caustic  potash,  is  soluble  in 
hydrochloric  acid,  and  is  melted  into  a  transparent  pearly  glass 
under  the  blow-pipe. 

Symptoms. — The  general  symptoms  attending  the  presence  of 
urinary  calculi  in  the  child  are  pretty  well  marked.  The  appe- 
tite is  irregulai',  digestion  is  impaired,  and  frequently  there  are 
well  marked  dyspeptic  symptoms.  The  secretions  are  deranged, 
the  skin  being  very  susceptible  to  external  impressions,  at  times 
dry  and  harsh,  at  others  soft,  relaxed  and  flabby,  with  cold  ex- 
tremities. The  bowels  are  torpid  and  sluggish  in  most  cases,  but 
in  some  the  irritation  of  the  bladder  extends  to  the  bowels,  and 
there  are  frequent  discharges.  The  patient  is  irritable  and  fret- 
ful, and  extremely  restless,  and  dissatisfied  with  everything  done 
for  it. 


374  DISEASES  OF  CHILDREN. 

The  local  symptoms  are  sometimes  very  marked,  in  other  cases 
the  patieut  will  have  to  be  observed  for  some  time  before  we 
have  such  evidence  as  will  lead  us  to  make  the  necessary  exam- 
ination. 

There  is  some  difficulty  in  passing  water,  but  it  is  not  constant, 
as  at  one  time  the  urine  may  be  evacuated  without  any  trouble  ; 
at  another  t\me  the  urine  will  be  stopped  in  its  passage,  with 
more  or  less  pain  and  tenesmus.  Occasionally  at  such  times  the 
orine  will  be  stained  with  blood. 

As  the  case  advances  the  difficulty  in  passing  urine  becomes 
more  frequent,  and  is  attended  with  greater  suiFering.  The 
patient  suffers  from  sense  of  weight  and  pain  in  the  bladder, 
loins,  and  small  of  the  back,  sometimes  so  severely  that  the 
countenance  presents  that  peculiar  contracted  anxious  expression, 
which  we  observe  in  long-continued  painful  diseases. 

Progressing  in  this  way  the  child  becomes  exhausted  from  the 
long  continuance  of  suffering,  and  the  functional  derangements 
that  follow  it,  and  will  succumb  to  this,  or  to  some  local  disease 
of  the  pelvic  viscera  induced  by  the  calculus. 

Diagnosis. — The  uneasy  sensations  in  the  bladder,  with  diffi- 
culty in  passing  urine,  point  to  the  bladder  as  the  seat  of  disease, 
while  the  long  duration  of  it  and  its  intractability  would  lead  us 
to  suspect  the  presense  of  a  calculus.  To  determine  this  a  sound 
is  introduced  into  the  bladder,  and  careful  manipulation  will 
detect  its  presence. 

Prognosis. — The  prognosis  may  be  regarded  as  favorable, 
whether  we  conclude  to  practice  lithotrity  or  lithotomy — both 
these  operations  being  successful  in  the  young. 

Treatment. — Having  determined  upon  an  operation,  we 
prepare  the  patient  for  it  as  best  we  may,  in  the  short  time  we 
have.  I  think  it  of  advantage  to  keep  the  patient  very  still  for 
a  few  days,  giving  small  doses  of  Aconite  and  Gelseminum,  with 
some  demulcent  diuretic  to  relieve  the  irritation  of  the  bladder. 
In  some  cases  much  relief  will  be  obtained  if  the  child  lies  upon 
its  abdomen  a  portion  of  the  time,  as  it  removes  the  pressure 
from  the  base  of  the  bladder. 

In  the  meanwhile  we  see  that  the  stomach  is  placed  in  condi- 
tion to  take  and  digest  some  food;  and  we  may  use  the  tincture 


IMPERFORATE  URETHRA.  375 

of  muriate  of  iron  aud  glycerine  as  a  restorative.  Quinine  iu- 
unetions  will  prove  beneficial  in  some  cases,  giving  strength  to 
the  nervous  system. 

Lithotrity.is  preferred  by  many  surgeons  at  the  present  time, 
as  giving  good  results,  notwithstanding  the  smallness  of  the 
urethra.  The  calculi  of  children  are  generally  more  friable  than 
in  the  adult,  and  are  much  easier  crushed,  and  the  urethra  may 
be  dilated  so  as  to  admit  a  good  sized  instrument. 

Lithotomy  is  performed  in  the  usual  way,  the  lateral  operation 
being  preferred.  Though  it  is  not  prudent  to  make  the  large 
incision  permitted  in  the  adult,  but  with  a  little  care  in  its  dila- 
tion with  the  finger,  and  in  seizing  the  stone  so  as  to  present  its 
smallest  diameter,  there  will  be  no  trouble  in  its  extraction. 

The  principal  points  in  the  after  treatment  are  to  keep  the 
patient  quiet,  keep  down  the  febrile  action,  and  the  stomach  in 
condition  to  receive  food. 

When  the  child  has  recovered  from  the  operation,  it  should  be 
put  upon  such  a  course  of  treatment  as  was  named  for  dyscrasias. 

In  addition  to  this  tonic  and  alterative  plan,  it  may  be  possi- 
ble to  employ  special  means  to  antidote  the  tendency  to  calcu- 
lous formations.  The  information  necessary  for  this  will  be 
found  in  my  work  on  Practice,  pp.  357  to  366 

IMPERFORATE    URETHRA. 

Karely  a  case  of  imperforate  urethra  will  be  met  with  in  the 
new-born  child.  The  malformation  will  be  brought  to  the  phy- 
sician's notice  by  the  child  not  passing  urine,  and  suffering  pain 
in  consequence  of  it.  An  examination  will  determine  the  char- 
acter of  the  lesion. 

In  other  cases  the  urethra  terminates  by  false  openings  in  the 
upper  or  under  surface  of  the  penis — hypospadias  and  epispadias. 
These  are  rarely  more  than  one  inch  from  the  meatus,  frequently 
not  more  than  half  an  inch. 

Treatment. — In  imperforate  urethra  the  difficulty  may  be 
remedied  by  passing  a  large  exploring  needle,  or  small  trocar, 
through  the  meatus  and  carrying  it  upward  until  it  reaches  the 
free  portion  of  the  canal.  A  silver  catheter  being  now  intro- 
duced it  is  worn  until  the  part  heals. 

In  hypospadias,  and  epispadias,  though  there  is  no  danger  to 


376  DISEASES   OF    CHILDREN. 

life,  I  think  that  the  malformation  should  be  remedied  in  infancy, 
as  it  can  be  best  done  at  this  time  and  with  the  least  danger. 
Open  up  the  canal  of  the  urethra  in  the  manner  above  named,  and 
passing  a  catheter,  retain  it  for  the  urine  to  pass  through. 
Then  freshen  the  edges  of  the  artificial  opening,  and  draw  them 
together  with  a  silver  suture.  If,  as  in  some  cases,  the  canal 
really  terminates  with  the  false  opening,  I  would  operate  by  de- 
taching the  skin  at  that  part,  if  not  too  far  up,  bring  it  down  to 
the  glans  and  attach  it  with  silver  ligatures,  retaining  a  catheter 
until  the  part  had  healed. 

PHYMOSIS. 

The  natural  condition  of  the  penis  in  the  child  is,  with  the 
elongated  and  contracted  foreskin  entirely  covering  the  glans. 
It  is  only  in  exceptional  cases  that  this  is  a  source  of  trouble. 

In  one  of  these  cases  an  inflammation  of  the  prepuce  and  glans 
is  set  up,  and  there  is  a  free  discharge  of  pus.  Sometimes  the 
inflammation  runs  high,  and  the  prepuce  is  so  swollen  as  to 
render  the  passage  of  urine  very  difficult  and  painful.  This  is 
really  a  case  of  infantile  balanitis,  and  being  difficult  of  cure,  or 
recurring  frequently,  it  may  require  removal  of  the  prepuce. 

In  the  other  case,  the  prepuce  being  quite  long  and  much  con- 
tracted, is  irritated  and  inflamed  by  the  urine,  so  as  to  be  a  source 
of  very  great  annoyance.  I  have  seen  two  cases  in  which  this 
was  a  source  of  serious  disease,  and  there  was  but  the  one  way 
for  its  removal,  and  that  by  removal  of  the  prepuce. 

Treatment. — Circumcision  is  very  readily  performed  in  the 
child,  and  is  not  attended  with  any  danger.  The  method  I 
would  recommend  is  to  take  the  foreskin  between  the  thumb  and 
finger  for  half  an  inch,  then  drawing  it  down  well  to  clear  the 
glans  penis,  excise  it  with  a  bistoury,  cutting  toward  the  finger. 
But  if  afraid  that  you  may  wound  the  glans,  draw  down  the  pre- 
puce with  the  fingers,  and  have  an  assistant  grasp  it  next  the  glans 
with  a  pair  of  dressing  forceps,  or  the  arms  of  a  pair  of  scissors, 
then  cut  between  the  fingers  and  it.  Retract  the  foreskin  and 
apply  a  water  dressing  until  the  part  heals. 

Some  may  make  objection  to  circumcision,  as  was  once  the 
case  in  my  practice.  The  mother  declared  she  would  not  have 
her  child  made  a  Jew  of,  oven  though  the  penis  had  to  be  cut  off. 
In  this  case,  simple  incision  of  the  prepuce  on  a  grooved  director, 


URETHRITIS  377 

its  entire  length,  retracting  it  over  the  glans,  and  retaining  it 
with  adhesive  straps,  was  all  that  was  required. 

PARAPHYMOSIS. 

Paraphymosis  is  the  retraction  of  a  tight  prepuce  above  the 
glans  penis  It  is  occasionally  met  with  in  boys  of  from  six  to 
ten  years,  who  have,  out  of  curiosity,  or  prompted  by  those 
older^  pushed  the  foreskin  back  and  have  not  been  able  to  return 
it  The  glans  becomes  swollen  and  painful,  and  if  the  constric- 
tion continues  long  it  may  go  on  to  inflammation  and  finally  to 
sloughinjr. 

In  many  cases  the  application  of  cold  water  or  ice  for  a  short 
time  will  reduce  the  swelling  and  permit  the  foreskin  to  be  drawn 
down.  It  is  also  claimed  that  if  a  couple  of  hairpins  are  used, 
pressing  the  bent  end  up  under  the  prepuce  on  each  side  of  the 
glans,  the  prepuce  can  be  drawn  down  over  them.  If  this  does 
not  succeed,  or  if  so  long  a  time  has  already  elapsed  that  we  do 
not  think  it  prudent  to  try  these  means,  we  will  incise  the  pre- 
puce and  thus  free  it.  This  is  easily  accomplished  by  passing  a 
grooved  director  under  the  foreskin  on  the  dorsum  of  the  penis, 
and  cutting  outward  with  a  sharp-pointed  bistoury. 

URETHRITIS. 

Urethritis  in  the  child  is  of  very  unfrequent  occurrence,  yet 
occasionally  a  case  will  be  met  with.  It  is  pretty  difficult  to 
determine  the  cause  of  the  inflammation.  Sometimes  it  is  un- 
doubtedly venereal,  and  has  been  contracted  from  the  clothing  of 
some  persons  about  the  house  affected  with  the  disease,  or  some- 
times by  being  nursed  by  such  persons.  The  only  case  I  ever 
met  with  was  as  marked  a  case  of  gonorrhoea  as  ever  I  saw  in  the 
adult.  The  boy  was  about  four  years  old,  not  yet  in  pants,  and 
was  nursed  frequently  by  an  uncle  who  was  suffering  from  the 
disease. 

Symptoms. — The  child  will  complain  of  pain  in  passing  urine, 
and  if  the  disease  is  severe,  will  suffer  intensely  from  this  cause. 
Upon  examination,  the  prepuce  will  be  found  much  swollen,  the 
penis  tender,  and  a  more  or  less  abundant  discharge  will  pass 
from  the  urethra. 


378  DISEASES    OF    CHILDREN. 

Treatment. — Of  course,  it  is  hardly  possible  to  determine 
the  cause  of  the  difficulty,  and  we  will  treat  it  as  a  simple  in- 
flammation. The  parts  should  be  kept  scrupulously  clean,  and 
if  the  inflammation  runs  high,  a  warm  hip-bath  may  be  used 
once  or  twice  during  the  day,  and  some  soft  poultice  at  night. 

Internally  I  would  prescribe,  ^  Tincture  of  Canabis  Indica, 
Tincture  Veratrum,  aa.  gtt.  v.,  water  giv.;  a  teaspoonful  every 
two  hours.  The  bowels  might  be  opened  with  a  saline  cathartic 
every  three  or  four  days,  but  active  catharsis  is  to  be  avoided. 

HYDROCELE. 

Hydrocele  is  occasionally  met  with  in  young  children,  and 
gives  rise  to  considerable  alarm  upon  the  part  of  the  parents. 
In  some  cases  it  is  congenital,  the  inguinal  canal  not  having  been 
closed  after  the  descent  of  the  testes.  In  these  it  may  sometimes 
be  associated  with  congenital  hernia. 

Our  attention  having  been  called  to  the  enlarged  scrotum,  we 
will  endeavor  to  determine  its  cause  by  an  examination.  If  the 
enlargement  is  caused  by  the  distension  of  the  tunica  vaginalis 
with  water,  palpation  will  detect  the  movement  of  the  fluid,  and 
when  the  child  cries  we  will  find  no  movement  communicated  to 
the  swollen  scrotum.  On  the  contrary,  if  a  scrotal  hernia  exist, 
the  movements  of  the  diaphragm  in  the  act  of  crying,  will  be 
communicated  to  the  hand  supporting  the  scrotum.  In  this  case 
also,  there  will  be  no  movement  from  side  to  side,  as  when  dis- 
tended with  fluid.  The  diagnosis  between  hydrocele  and  hema- 
tocele is  readily  effected  in  the  child  by  the  marked  change  of 
color  in  the  last. 

Treatment. — In  some  cases  we  will  be  successful  in  removing 
the  fluid  and  curing  the  disease  by  a  stimulating  application  and 
compression.  The  use  of  a  strong  infusion  of  Hamamelis,  with 
a  well  adjusted  bandage,  in  the  usual  form  of  a  suspensory  band- 
age, was  attended  with  success  in  one  case  that  came  under  my 
notice.  Mayer's  ointmeiit  would  prove  a  good  application,  as 
would  also  a  soft  piece  of  leather,  cut  to  fit  the  part  and  spread 
with  our  ordinary  strengthening  plaster.  Tincture  of  iodine  has 
been  recommended  as  an  application  to  the  part,  to  stimulate  ab- 
sorption, but  I  think  it  would  be  too  irritating. 

If  these  means  should  not  succeed,  the  scrotum  may  be  ]Mino- 


INFANTILE   LEUCOERHCEA.  379 

tared  with  an  exploring  needle  or  small  trocar,  and  the  fluid 
drawn  off.  If  now  the  part  is  supported  by  a  well  adjusted 
bandage,  we  may  expect  a  radical  cure. 

INFANTILE   LEUCORRHCEA. 

A  slight  discharge  from  the  vulva  is  not  of  unfrequeut  occur- 
rence in  children  from  one  to  twelve  years  of  age,  but  it  is  only 
in  exceptional  cases  that  it  is  severe,  and  produced  by  an  active 
inflammation  at  first,  but  which,  as  it  declines,  becomes  chronic 
and  very  stubborn.  These  last  are  very  troublesome  cases,  and 
are  a  source  of  great  annoyance  both  to  the  physician  and  the 
family. 

Causes. — The  slight  discharge  is  the  effect  of  cold,  after  over- 
exertion in  the  use  of  the  lower  limbs,  or  occasionally  from  sit- 
ting on  the  damp  ground,  or  a  stone.  This  may  also  be  a  cause 
of  the  active  inflammation,  or  it  may  be  produced  by  acridity  of 
the  urine,  irritating  and  excoriating  the  vulva,  the  inflammation 
arising  in  and  extending  from  this  part.  In  some  cases  it  may 
arise  from  want  of  cleanliness,  especially  in  those  Avho  are  badly 
nourished. 

Tiien  we  have  exceptional  cases,  in  which  the  inflammation  is 
specific  in  its  character,  and  is  produced  by  contact  Avith  gonor- 
rhoeal  virus.  This  may  occur  in  a  house  where  some  person  has 
gonorrhoea,  from  sitting  on  the  privy  seat,  or  by  the  use  of  cloths 
impregnated  with  the  virus. 

Pathology. — In  the  slight  cases  there  is  simply  an  increased 
circulation  in  the  parts,  and  activity  of  the  mucous  follicles. 
Usually  this  is  confined  to  the  glands  about  the  vulva,  and  the 
vulvo-vaginal  glands. 

In  the  severer  form,  there  is  a  well  marked  inflammation,  in- 
volving the  parts  about  the  commencement  of  the  vagina,  the 
vulva,  and  sometimes  extending  up  the  entire  length  of  the 
vaginal  canal.  The  inflammation  loses  its  active  character  after 
the  first  ten  days,  and  the  parts  present  a  swollen,  deep-red  ap- 
pearance, bathed  with  muco-pus.  There  is  no  means  of  deter- 
mining from  the  appearance  of  the  parts,  whether  it  has  arisen 
from  gonorrhneal  virus,  or  not. 

Treatment. — The  treatment  is  unsatisfactory  in  many  cases, 
from  the  difficulty  we  experience  in  getting  a  proper  application 


380  DISEASES   OF   CHILDREN. 

of  local  remedies.  Indeed,  with  the  best  assistance  the  mother 
can  give,  we  make  but  slow  progress. 

I  put  the  child  upon  the  use  of  Aconite  with  Cannabis  Indica 
in  the  usual  doses;  or  in  place  of  tlie  last  we  might  give  the  Gel- 
sem.inum.  The  bowels  are  gently  opened  by  citrate  of  magnesia 
or  phosphate  of  soda  every  two  or  three  days.  If  the  child  is 
old  enough  to  take  it,  she  may  use  an  infusion  of  equal  parts  of 
Althaea  and  Uva  Ursi  as  a  drink. 

I  now  use  salicylic  acid  and  borax  or  chlorate  of  potash  as  the 
local  application,  as — ^t  Salicylic  Acid,  Borax  (or  Chlorate  of 
Potash),  aa.  gr.  xx.,  water  Oj.  This  maybe  applied  to  the  vulva 
only,  or  if  the  discharge  is  vaginal  it  may  sometimes  be  used 
Avith  a  syringe.  Bathing  the  parts  with  hot  water  alone  (as  hot 
as  can  be  borne  comfortably)  will  sometimes  effect  a  cure.  The 
hot  bath  may  extend  to  the  abdomen  and  spine. 

Perseverance  in  these  means  will  relieve  the  acute  inflamma- 
tion, and  many  times  will  effect  a  radical  cure.  But  if  a  chronic 
discharge  continues,  we  will  obtain  the  best  results  from  the  local 
use  of  a  solution  of  Sulphate  of  Hydrastia  grs.  iv.,  to  water  §iv. 

There  are  many  other  local  remedies  that  have  been  used  in  this 
case,  but  they  are  the  same  as  recommended  for  the  adult,  and 
for  these  the  reader  is  referred  to  treatises  on  disease  of  women. 

The  general  treatment  in  the  chronic  form  of  the  disease,  will 
be  of  a  tonic  and  restorative  character.  Further  than  this,  it  is 
doubtful  if  any  internal  remedies  can  be  used  with  benefit  to  the 
local  disease. 

ONANISM. 

The  practice  of  onanism  is  of  very  common  occurrence  after 
the  twelfth  year,  or  about  the  commencement  of  puberty.  But 
at  an  earlier  age  than  this,  we  will  find  occasional  instances  of 
the  vice,  which  will  give  us  much  trouble.  I  have  seen  it  as 
early  as  the  second  year,  and  in  one  case,  the  boy  being  in  his 
fourth  year,  it  had  proven  a  cause  of  severe  constitutional  dis- 
turbance. 

It  is  difficult  to  determine  the  cause  of  the  habit  in  children  of 
this  age,  as  the  organs  arc  yet  undeveloped,  and  we  are  taught 
to  believe  that  the  venereal  appetite  is  not  present  until  the  age 
of  puberty.  It  is  my  impression  that  the  habit  of  handling  tlie 
parts,   is   sometimes   attained  at  a   very  early  age,   and  attended 


ONAKISM.  ,  381 

with  erections,  is  found  pleasurable,  and  is  repeated  for  this 
reason.  I  have  noticed  this  occasionally,  and  even  in  this  slight 
degree,  if  continued  but  for  two  or  three  months,  it  will  give  rise 
to  marked  irritability  of  the  nervous  system  and  impaired 
health. 

In  the  severe  cases  we  find  the  child  has  lost  flesh  and  is  much 
debilitated.  There  is  marked  depression  of  the  nervous  system, 
and  the  child  has  a  furtive  and  uneasy  look.  It  is  easy  to  see 
that  the  mind  is  affected,  that  the  child  does  not  receive  natural 
impressions,  and  that  its  reasoning  power  is  impaired.  Some- 
times it  seems  to  suffer  from  spinal  disease,  at  others  from 
disease  of  the  lower  extremities,  and  again  from  disease  of 
the  brain.  Some  cases  seem  to  be  dependent  upon  inactivity 
of  the  stomach  and  bowels — dyspepsia — and  treatment  is  direct- 
ed to  this  with  the  expectation  of  restoring  the  health*  and 
strength,  by  the  use  of  bitter  tonics  and  restoratives. 

I  recognize  the  difficulty  by  the  furtive  uneasy  look  of  the 
patient,  and  by  the  disposition  to  rub  the  thighs  together,  and 
move  the  lower  part  of  the  body.  In  the  milder  cases,  the  child 
does  not  seem  to  appreciate  but  what  it  is  all  right,  and  will 
carry  the  hand  to  the  penis  while  you  are  conversing  with  him. 
In  the  protracted  cases,  the  child  seems  as  much  impressed  with 
the  offense  as  the  adult,  especially  if  he  has  been  reproved  for  it; 
and  practises  it  secretly  whenever  he  has  an  opportunity.  If  the 
penis  is  examined  in  these  cases,  the  pi'epuce  will  be  found  red 
and  irritated,  and  occasionally  the  organ  will  be  more  developed 
than  is  usual  at  the  age. 

If  continued,  the  practice  will  lead  to  epilepsy,  idiocy,  or  to 
such  impairment  of  the  general  health  that  the  child  will  die 
early  of  some  cachectic  disease. 

Treatment. — In  the  milder  cases,  those  which  have  continued 
but  a  month  or  two,  we  may  break  up  the  habit  by  close  atten- 
tion and  mild  reproof.  Gentle  means  are  much  better  than 
harsh,  persuasion  than  force,  and  if  the  matter  is  properly  pre- 
sented to  the  parentvS,  and  they  will  take  advice,  we  will  get 
along  with  the  patient  well. 

When  the  habit  is  well-established,  I  put  it  beyond  the  child's 
power  to  continue  it,  by  vesicating  the  surface  so  that  handling 
will  be  painful,  and  an  erection  impossible.  Tincture  of  Cunthar- 
ides,  or  Cantharidal  Collodion  will  answer  this  purjx)se  well.     It 


382  «       DISEASES  OF    CHILDREN. 

should  always  be  applied  without  the  patient's  knowing  of  the 
purpose  for  which  it  is  used,  which  can  very  readily  be  done,  and 
it  should  be  so  repeated  that  for  one  or  two  months  the  oro-an 
must  remain  at  rest. 

In  the  meanwhile,  by  the  use  of  tonics  and  restoratives,  nutri- 
tious diet,  baths,  and  exercise  in  the  open  air,  we  restore  the 
general  health,  and  at  the  end  of  a  couple  of  months  we  find  the 
habit  broken  and  the  health  restored. 

If  the  difficulty  should  still  continue  circumcision  is  a  most 
eflPectual  remedy.  If  parents  will  not  consent  to  the  complete 
removal  of  the  prepuce,  it  may  be  slit  up  on  a  grooved  director, 
and  the  glans  exposed. 


CHAPTER     IX. 

DISEASES   OF  THE   NERVOUS   SYSTEM. 


Lesions  of  the  nervous  system  exert  a  very  important  influence 
in  disease,  and  we  rarely  find  a  case  in  which  they  do  not  form  a 
part,  and  must  be  estimated  in  the  diagnosis.  They  also  exert 
a  more  or  less  marked  influence  on  all  pathological  changes,  and 
it  is  through  the  nervous  system,  to  a  considerable  extent,  that 
we  are  enabled  to  modify  and  change  the  various  processes  of 
life. 

The  nervous  system  of  the  child  is  peculiarly  susceptible  to 
the  causes  of  disease,  and  as  susceptible  to  the  influence  of  reme- 
dies. Hence,  minute  doses  of  direct  medicines  are  found  prefera- 
ble to  large  doses  of  such  as  act  in  an  indirect  manner. 

It  will  be  recollected  that  the  nervous  system  is  divisible  into 
three  parts — the  brain,  the  spinal  cord,  and  the  sympathetic 
nervous  system. 

The  brain  is  the  organ  of  the  mind,  and  gives  us  conscious  ex- 
istence, and  from  it  the  will  calls  into  action  the  voluntary  mus- 
cles to  serve  its  purposes.  As  a  whole  it  is  an  element  of  weak- 
ness, and  draws  upon  the  vegetative  functions  for  its  life,  rather 
than  giving  strength  or  aid  to  them.     The  popular  opinion  "that 


DISEASES  OF  THE  NERVOUS  SYSTEM.  383 

a  child  may  have  too  much  brain/'  like  many  such,  is  founded 
in  fact.  The  large  brain,  as  compared  with  the  body,  appropri- 
ates an  excess  of  blood,  nutritive  material,  and  vital  or  formative 
power,  and  the  remainder  of  the  body  suffers  in  consequence. 

It  is  essential  to  success,  in  some  cases,  to  see  that  this  morbid 
growth  of  the  brain  be  arrested.  This  is  accomplished  by  adopt- 
ing such  a  course  of  training  as  will  develop  the  body  and  keep 
the  miiid  at  rest. 

The  basilar  portion  of  the  brain  is  an  expansion  of  the  spinal 
cord,  and  influences  vital  processes.  The  tenacity  of  life  and 
power  of  living  depend,  to  a  very  considerable  extent,  upon  its 
development  and  perfect  condition.  We  have  already  seen  that 
this  power  may  be  very  closely  estimated  by  a  measurement  de- 
termining the  depth  of  the  basilar  portion  of  the  brain. 

The  spinal  cord  is  the  center  of  reflex  action,  or  automatic 
movements.  It  carries  on  certain  functions  when  the  will  is  in 
abeyance,  and  others  that  are  but  partially  under  the  influence 
of  the  will.  The  functions  of  respiration,  deglutition,  defeca- 
tion, etc.,  and  all  the  involuntary  movements,  are  carried  on  un- 
der its  control.  Nerves  from  this  source  pass  to  all  parts  of  the 
body,  and  we  know  that  they  may  take  complete  control  of  all 
the  voluntary  functions,  usurping  the  place  of  the  brain. 

The  sympathetic  nervous  system  presides  over  the  functions 
of  vegetative  life,  controlling  digestion,  assimilation,  blood-mak- 
ing, the  circulation  of  the  blood,  nutrition,  waste  of  tissue,  secre- 
tion and  excretion.  Though  the  entire  amount  of  gray  nerve 
substance  in  the  sympathetic  ganglia  of  the  body  would  not  be 
the  size  of  a  pigeon's  egg,  it  is  probable  there  is  no  structure  in 
the  body,  however  minute,  but  what  receives  nervous  supply  from 
this  source. 


DETERMINATION  OF  BLOOD  TO  THE  BRAIN. 

Determination  of  blood  to  the  brain  is  of  frequent  occurrence 
in  acute  disease.  We  understand  that  determination  is  the  result 
of  irritation,  but  we  can  only  account  for  this  by  the  supposition 
that  it  follows  from  the  accelerated  circulation  and  increase  of 
temperature.  The  immature  brain  is  very  susceptible  to  irrita- 
tion, and  but  slight  change  in  its  vital  condition  is  required  to 
induce  it. 


384  DISEASES   OF   CHILDEEN. 

Symptoms. — Determination  to  the  brain  is  annouriced  by  the 
increased  restlessness  and  irritability  of  the  patient.  The  face  is 
flushed,  the  eyes  bright,  the  pupils  contracted,  and  the  head  hot- 
ter than  usual.  These  symptoms  gradually  increase  until  they 
become  very  marked,  the  child  suffering  severely  from  it,  and 
occasionally  having  convulsions. 

With  determination  to  the  brain  all  the  other  symptoms  are 
increased.  The  pu-lse  is  more  frequent,  the  temperature  higher, 
greater  arrest  of  the  secretions,  less  disposition  to  sleep,  and  fur- 
ther impairment  of  the  digestive  organs. 

It  may  continue  to  increase  until  an  inflammation  is  estab- 
lished, or  after  some  days  terminate  in  the  opposite  condition  of 
congestion,  from  exhaustion  of  the  irritability  of  the  brain. 

Treatment. — The  treatment  of  determination  of  blood  to  the 
brain  in  childhood  is  direct  and  certain.  The  use  of  Gelseminum, 
associated  with  the  special  sedatives,  will  meet  the  indications  in 
almost  every  case.  But  the  specific  action  of  the  remedy  is  only 
obtained  from  the  one  preparation — a  tincture  made  from  the 
green  root ;  the  most  that  is  sold  is  wholly  worthless  for  any  pur- 
pose in  medicine.  In  this  form  I  prescribe  it  in  the  following 
proportions :  Iji  Tincture  Gelseminum  gtt.  v.  to  gtt.  x.,  Tinct. 
Aconite  gtt.  v.,  water  .^iv.;  a  teaspoonful  everyone  or  two  hours. 

If  the  features  are  contracted,  expressive  of  pain,  and  the  child 
starts  in  its  sleep,  and  cries  out  shrilly,  Rhus  will  take  the  place 
of  Gelseminum,  in  the  proportion  of  gtt.  v.  to  water  5iv. 

With  this  treatment  we  employ  the  general  bath  and  the  hot 
foot-bath  ;  the  last  frequently  repeated,  and  if  the  head  is  hot,  it 
is  sponged  with  warm  water,  and  evaporation  is  promoted  by 
fanning.  Catharsis,  counter-irritation,  and  ice  to  the  scalp,  should 
be  avoided. 


CONGESTION   OF   THE   BRAIN. 

Congestion  is  that  condition  in  which  there  is  excess  of  blood 
in  a  part,  with  its  movement  impaired.  It  may  arise  from  irri- 
tation of  the  brain  at  first,  but  usually  depends  upon  some  cause 
which  depresses  the  vitality  of  the  organ.  The  circulation  is 
feeble  and  slug<;ish,  while  the  vessels  are  unduly  distended,  and 
necessarily  the  function  of  the  organ  is. impaired. 


PHRENITIS.  080 

Symptoms. — The  child  is  dull  and  inactive,  wants  to  sleep 
much,  and  usually  sleeps  with  its  eyes  partially  open.  The  dull- 
ness and  hebetude  are  so  marked  that  they  cannot  escape  notice. 
As  the  disease  progresses  we  find  this  condition  increased;  the 
child  sleeps  a  considerable  part  of  the  time,  but  it  is  not  so  much 
sleep  as  stupor,  and  gradually  this  passes  into  coma,  which  at 
last  becomes  so  profound  that  the  child  can  not  be  aroused 
from  it. 

AVith  this  condition  of  the  brain  the  whole  system  sympathizes, 
and  there  is  atony  with  tendency  to  sluggish  circulation,  and 
consequent  arrest  of  function  in  every  part. 

Treatment. — This  condition  of  the  child,  like  the  preceding, 
I  prefer  to  treat  with  a  specific,  rather  than  to  depend  upon  the 
old  means — counter-irritation  and  catharsis.  Belladonna  is  the 
remedy,  and  I  would  prescribe  it  in  the  following  form :  ]^ 
Tincture  of  Belladonna  gtt.  v.,  Tincture  Aconite  gtt.  ij.  to  gtt.  v., 
water  .5i v.,  a  teaspoonful  every  hour.  I  think  the  remedy  will 
very  rarely  disappoint  expectation,  as  I  have  successfully  em- 
ployed it  for  this  purpose  for  many  years,  and  it  has  been  used 
very  extensively  by  others  with  like  results. 

It  may  be  aided  by  the  use  of  the  hot  mustard  foot-bath,  con- 
tinued for  thirty  minutes  at  a  time,  and  repeated  two  or  three 
times  a  day,  and  in,  very  severe  eases  by  dry  cups  to  the  neck. 

AVhen  the  condition  is  so  marked,  that  it  will  evidently  prove 
fatal  if  not  speedily  removed,  I  have  been  accustofned  to  employ 
a  prompt  and  thorough  emetic,  and  follow*  with  the  Belladonna. 
This  treatment  may  be  recommended  in  those  very  severe  cases 
sometimes  met  with  in  the  eruptive  fevers,  in  which  the  emetic 
will  throw  off  the  profound  coma,  and  give  freedom  to  the  circu- 
lation and  the  respiration.  I  trust  to  the  Belladonna  to  accom- 
plish this  result  in  children  under  one  year,  and  it  has  so  far 
proved  satisfactory.  Still  there  are  very  many  who  will  -not 
have  faith  in  such  small  doses  of  a  single  remedy,  for  the  relief 
of  so  grave  a  condition. 

PHRENITIS. 

Inflammation   of  the  brain   is  of  more  frequent  occurrence  in 
childhood  than  in  the  adult.     It  is  rarely  an   idiopathic  disease, 
but  when  seen  it  is  a  complication  of  some  other  affection,  usu- 
25 


386  DISEASES   OF   CHILDREN.  ' 

ally  a  fever  or  inflammation.  As  it  is  preceded  by  determina- 
tion of  blood,  the  symptoms  of  which  are  well  marked,  and  the 
remedies  employed  almost  specific,  an  iiuflammatiou  of  the  brain 
should  be  of  very  rare  occurrence. 

Causes. — An  inflammation  of  the  brain  may  arise  from  any 
of  the  causes  that  would  produce  inflammation  of  any  other 
organ  or  part ;  but,  as  we  have  seen  above,  such  origin  is  very 
rare.  Occurring,  in  a  majority  of  cases,  during  the  progress  of 
an  acute  fever  or  inflammation,  it  is  dependent  upon  an  irrita- 
tion produced  by  the  accelerated  circulation  and  increase  of  heat. 
It  occurs  in  such  persons  as  have  a  natural  irritability  of  the 
brain  and  nervous  system.  These  changes  prove  sufiicient  to' 
establish  an  irritation,  which  is  followed  by  determination  and 
inflammation. 

Pathology. — The  inflammation  may  be  confined  to  the  dura 
mater  and  arachnoid — cerebral  meningitis ;  or  it  may  affect  the 
substance  of  the  brain  itself — cerebritis.  But  it  is  impossible,  by 
the  symptoms  presented,  to  determine  the  difference  between  the 
two  during  life.  The  inflammation  presents  its  usual  features  ;  • 
a  first  stage,  in  which  there  is  an  active  circulation,  the  structures 
being  filled  with  blood,  and  presenting  similar  appearances  to 
those  seen  in  superficial  imflammation ;  and  a  second  stage,  in 
which  there  is  stasis  of  blood  and  exudation  into  the  connective 
tissue. 

Post-mortem  examination  shows  the  seat  of  the  lesion.  If  of 
the  membranes,  the  dura  mater  and  the  arachnoid  will  be  found 
injected  in  patches  of  greater  or  less  extent.  There  is  also  an 
increased  quantity  of  fluid,  sometimes  but  little  changed,  at 
others  moreor  lessviscid,  or  containing  flocculi  of  coagulable  lymph. 
When  the  acute  stage  has  continued  for  three  or  four  days,  we 
sometimes  find  adhesions  between  the  free  surfaces.  When  the 
substance  of  the  brain  has  been  involved,  the  vesicles  of  the  pia 
mater  are  distended,  and  on  making  an  incision  into  the  convo- 
lutions, the  cut  surface  will  present  a  more  uniform  red  color 
than  natural,  and  the  puncta  vasculosa  are  more  numerous  and 
larger. 

SYMPTO^rs. —  The  invasion  of  the  disease  is  indicated  by  a 
sense  of  fullness  and  pain  in  the  head,  the  integuments  being 
suffused,  and  sometimes  a  marked   sense   of  heat.     Frequently 


PHEENITIS.  387 

the  patient  complains  of  dullness,  with  confusion  of  ideas  and 
forgetful ness,  and  unquiet  sleep.  Extreme  irritability  and  fret- 
fulness,  with  indisposition  to  sleep,  and  frequent  startings  dur- 
ing rest,  the  cry  being  sharp  and  quick,  as  if  terrified,  are  the 
precursory  symptoms  in  children.  The  disease  is  usually  ush- 
ered in  with  a  marked  rigor  or  chill,  continuing  for  an  hour 
or  two,  or  sometimes  for  nearly  a  whole  day.  Following  this, 
there  is  in  most  cases  high  febrile  reaction,  the  skin  is  hot  and 
flushed,  the  pulse  frequent  and  hard,  tongue  coated  white,  bow- 
els constipated,  and  urine  scanty  and  high-colored.  The  head 
is  turgid  and  hot,  the  eyes  more  prominent  and  suffused,  the 
pupils  contracted  and  fixed,  and  a  deep-seated,  heavy  pulsating 
and  tensive  pain  in  the  head. 

As  the  disease  progresses,  the  patient  becomes  more  irritable 
and  restless,  the  pain  in  the  head  increases,  there  is  intolerance 
of  light,  ringing  in  the  ears,  and  intolerance  of  sound,  sleepless- 
ness and  delirium.  Up  to  the  third  or  fourth  day  the  fever  is  usu- 
ally continuous,  though  sometimes  there  is  a  slight  remission  in 
the  forenoon,  and  the  head  symptoms  increase  or  continue  with- 
out abatement.  A  marked  change  is  now  observed,  the  acute 
sensibility  gives  way  to  torpor,  and  the  delirium  becomes  low 
and  muttering,  or  is  replaced  by  coma.  The  pulse  becomes  fuller, 
softer,  or  slow,  or  in  some  cases  very  hard  and  frequent.  The 
head  and  trunk  are  still  hot,  the  face  turgid  and  of  a  deeper 
color,  or  in  some  cases  blanched  and  contracted,  the  pupils  dila- 
ted, the  extremities  cool,  respiration  difficult  and  sometimes 
stertorous,  and  more  or  less  involuntary  movement  and  starting 
of  the  tendons.  The  coma  gradually  becomes  deeper,  ancf  the  in- 
sensibility more  marked;  all  the  functions  are  feebly  performed,  the 
patient  lies  on  his  back,  slips  down  to  the  foot  of  the  bed^  grasps 
at  imaginary  objects,  and  thus  slowly  sinks.  According  to 
Copland:  "In  some  cases,  particularly  those  in  which  the  cer- 
ebral substance  is  early  and  generally  inflamed  and  turgid,  in- 
stead of  phrenitic  delirium,  an  apoplectic  sopor,  often  preceded 
by  convulsions,  quickly  supervenes ;  with  a  slow  pulse,  stertor- 
ous, slow,  or  labored  breathing,  turgid  or  bloated  countenance, 
startings  of  the  tendons,  involuntary  evacuations,  torpor  of  the 
senses,  and  flaccidity  of  the  limbs."  Here  the  first  stage  is  very 
short,  or  not  noticed,  and  the  disease  passes  rapidly  to  a  fatal 
termination. 

In   children    we   frequently   find   inflammation  of  the  brain 


388  DISEASES  OF  CHILDREN. 

making  its  appearance  during  the  progress  of  other  diseases. 
The  head  becomes  hot,  the  face  turgid,  the  pupils  contracted, 
with  great  restlessness  and  constant  movement  of  the  head. 
Though  not  very  marked  on  account  of  age,  the  child  is  evident- 
ly delirious,  and  the  frequent  movement  of  the  head,  and  putting 
the  hands  up  to  it,  shows  that  it  suffers  pain.  In  other  cases  the 
acute  stage  has  passed  without  notice,  the  face  is  blanched  and 
contracted  or  white  and  puffy,  the  pulse  is  small  and  very  fre- 
quent, the  extremities  cool,  bowels  loose,  the  operations  being 
unnatural  and  offensive,  there  is  continued  movement  of  the 
head  and  restlessness,  or  a  deep  stupor  or  coma.  Sometimes  the 
symptoms  will  continue  for  three  or  four  days,  but  at  other 
times  the  disease  will  terminate  fatally  within  forty-eight  hours. 

Diagnosis. — It  is  not  difficult  in  the  most  of  cases  to  de- 
termine the  presence  of  phrenitis.  The  heat  and  turgidity  of  the 
face  and  scalp,  the  deep-seated  and  tensive  pain,  contracted  pu- 
pils, and  the  great  irritability  and  restlessness,  with  the  high 
grade  of  fever,  are  sufficient  for  the  diagnosis.  In  those  other 
cases  in  which  coma,  difficult  respiration,  full  but  oppressed 
pulse,  coldness  of  the  extremities,  dilated  pupils,  etc.,  are  the  at- 
tendant symptoms,  the  diagnosis  will  be  very  difficult,  and  if  we 
can  not  have  the  previous  history  of  the  case,  almost  im- 
possible. 

Prognosis. — In  the  first  stage  of  the  disease,  the  prognosis  is 
usually  favorable,  if  prompt  measures  are  adopted  for  the  arrest 
of  the  inflammation.  In  the  second  stage  the  lesions  are  so  great 
that  we  will  have  to  be  guarded  in  our  prognosis,  though  a  con- 
siderable number  will  recover. 

Treatment. — If  ca41ed  to  a  case  in  the  first  stage  of  the  disease, 
we  have  the  patient  thoroughly  bathed  with  the  alkaline  wash, 
drying  with  brisk  friction;  this  is  followed  by  a  hot  mustard 
foot-bath,  continued  for  half  an  hour,  and  both  are  repeated  once 
or  twice  daily.  Internally,  I  prescribe — ^  Tinct.  of  Aconite 
gtt.  v.,  Tinct.  Gelseminuni  gtt.  x,  water  S'V.;  a  teaspoonful  every 
hour.  If  the  fever  runs  high,  I  would  add  to  this,  Tinct.  of  Ve- 
ratrum  gtt.  x.,  for  a  few  hours. 

To  lessen  the  heat  of  the  head,  we  direct  that  it  be  s])onged 
with  warm  water  and  fanned,  to  produce  evaporation.  We  will 
find  quite  warm  water  is  very  agreeable  to  the  little  patient,  re- 


PHRENITIS.  389 

lieving  the  excitation  of  the  nervous  system,  and  lessening  the 
temperature.  We  never  apply  cloths  wrung  out  of  cold  water, 
as  is  the  common  practice,  or  bladders  of  pounded  ice,  as  recom- 
mended in  most  works.  This  is  not  nature's  method  for  remov- 
ing surplus  heat,  as  is  the  case  with  the  plan  first  named.  On 
the  contrary,  it  is  directly  depressant  in  its  first  influence,  and 
if  not  persistently  applied  there  will  be  a  corresponding  reaction; 
if,  therefore,  it  is  continued,  the  depression  may  cause  death  ;  if 
suspended,  the  reaction  is  higher  than  before,  and  the  patient  in 
greater  danger. 

I  do  not  approve  of  the  use  of  a  cathartic  in  all  cases,  for  while 
in  some  it  will  prove  beneficial,  in  others  it  exerts  an  unfavorable 
influence.  Never  give  a  cathartic  when  the  tongue  is  contracted, 
reddened  around  its  border  and  white  in  the  center,  or  when  it 
is  elongated  and  pointed.  In  this  case  it  is  quite  certain  to  irri- 
tate the  stomach  and  upper  intestine,  increasing  the  febrile  action 
and  the  disease  of  the  brain.  It  may,  however,  be  used  with 
good  efiiect  when  the  tongue  is  moist,  somewhat  broad,  and  tole- 
rably uniformly  coated  with  a  yellowish  or  grayish  fur.  I  would 
prefer  a  small  portion  of  jalap  with  a  saline,  as — I^  Jalap  grs.  iij. 
to  grs.  v.,  Bitartrate  of  Potash  gr.  v.  to  grs.  x. 

If  the  tongue  is  thus  coated,  sulphite  of  soda,  in  doses  of  two 
to  five  grains,  may  be  given  every  two  or  three  hours,  until  the 
tongue  cleans. 

So  soon  as  the  influence  of  the  special  sedative  is  observed,  we 
may  prescribe  a  solution  of  acetate  of  potash,  to  be  taken  largely 
diluted  with  water.  I  usually  give  it  as  a  drink,  and  as  the  child 
is  thirsty  it  will  be  taken  pretty  freely. 

In  some  cases  Rhus  is  a  very  important  remedy,  and  replaces 
the  Gelseminum.  The  indications  are  usually  very  clear :  the 
pulse  is  sharp,  the  tissues  about  the  eyes  and  base  of  brain  con- 
tracted, with  evident  frontal  headache,  and  the  tongue  shows  the 
red  papillae  at  its  tip. 

If  the  child  is  wildly  delirious,  and  clutches  at  its  mouth  and 
throat.  Stramonium  may  be  given  with  Veratrum,  aa.  gtt.  v., 
water  5iv .;  a  teaspoonful  every  hour. 

There  is  one  point  in  the  treatment  that  should  not  be  ne- 
glected— keeping  the  child  quiet — rest  to  the  nervous  system  being 
essential  to  complete  recovery.  I  prefer  that  the  child  shall  re- 
main in  the  recumbent  position  in  its  crib  or  bed,  with  the  room 
darkened,  and  as  little  noise  as  is  possible. 


390  DISEASES  OF   C  HILDREN. 

'  In  some  cases  there  is  extreme  irritation  of  the  stomach,  and 
it  becomes  important  that  this  should  be  relieved.  The  Aconite 
and  Gelseminum  will  have  to  be  in  very  small  dose,  aud  we  may 
need  to  add  portions  of  Aconite  aud  Gelseminum  to  the  water 
that  we  sponge  the  child's  head  with.  If  this  is  not  sufficient  to 
relieve  the  irritation,  peach  bark  may  be  used,  or  a  small  portion 
of  a  Seidlitz  powder  may  be  given  with  the  drink.  If  the  tem- 
perature is  high,  cold  packs  may  be  used 'over  the  stomach  and 
bowels ;  if  the  child  is  feeble,  hot  packs  or  sponging  will  be  bet- 
ter. With  a  temperature  of  105°  I  should  tiiink  of  an  enema  of 
of  four  to  eight  ounces  of  cold  salt  water ;  with  cool  extremities, 
the  water  should  be  as  hot  as  the  patient  can  bear  it. 

In  the  second  stage,  the  condition  is  wholly  changed.  Instead 
of  the  active  circulation  and  excitement  of  the  brain,  we  have  a 
stasis  of  blood  and  coma. 

Locally,  I  order  dry  cups  to  the  neck,  and  sometimes  to  the 
spine,  with  the  hot  mustard  foot-bath ;  the  first  being  repeated 
if  the  case  is  severe,  and  the  second  used  two  or  three  times  a 
day.  Evaporating  lotions  are  applied  to  the  scalp,  as  sulphuric 
ether,  alcohol,  or  cologne;  sometimes  a  camphor  or  arnica  lotion 
will  answer  the  purpose  well. 

Internally,  I  prescribe — I^  Tinct.  Aconite  gtt.  v.,  Tinct  Bel- 
ladonna gtt.  X.,  water  Siv.;  a  teaspoonful  every  hour.  Or  if 
there  is  fullness  of  the  fontanelles  or  swollen  eyelids,  we  might 
add  Tinct,  Apocynum  gtt.  x.  to  water  5iv.,  and  give  in  teaspoon- 
ful doses  alternately  with  the  Belladonna.  If  there  is  retention 
of  urine,  or  sluggish  passage,  Santonine  may  be  given  in  doses 
of  one-fourth  to  one  grain,  as  heretofore  named. 

If  there  is  the  condition  of  the  tongue  named  above  as  per- 
mitting the  use  of  a  cathartic,  I  should  give — ^  Jalap  grs.  iij., 
Capsicum  gr.  |,  Bitartrate  of  Potash,  gr.  x.,  and  repeat  it  every 
four  hours  until  it  acted  freely. 

To  act  upon  the  kidneys,  I  would  prefer  sweet  spirits  of  nitre 
in  doses  often  or  fifteen  drops,  every  two  hours,  as  it  is  also  an 
excellent  stimulant. 

In  some  cases  we  will  find  quinine  inunction  to  answer  a  very 
good  purpose.  If  there  is  much  prostration  and  feeble  circula- 
tion in  the  skin,  some  rubefacient  may  be  added  to  it,  as  one  of 
the  essential  oils,  or  the  oil  of  mustard  in  very  small  quantity. 
If  tlie  quinine  is  not  used  in  this  way,  it  may  be  given  internally 
to  the  extent  of  two  grains  a  day,  during  convalescence. 


ACUTE   HYDROCEPHALUS.  391 


ACUTE    HYDROCEPHALUS. 

We  use  tills  term,  for  the  want  of  a  better  one,  to  distinguish 
a  certain  class  of  cases  in  which  the  disease  of  the  brain  is  a 
principal  lesion,  though  the  symptoms  would  indicate  something 
else.  The  disease  is  confined  almost  entirely  to  children,  occur- 
ing  most  frequently  from  the  ages  of  one  to  three  years,  and  being 
rare  after  twelve.  It  is  very  difficult  to  determine  the  cause, 
though  we  are  of  the  opinion  that  it  is  frequently  dependent 
upon  irritation  of  the  digestive  apparatus,  or  upon  any  cause 
that  will  enfeeble  the  system.  At  the  age  of  ten  or  twelve  it  is 
usually  brought  on  by  over  mental  exertion. 

Pathology. — The  lesions  observed  in  this  disease  are  by  no 
means  constant.  In  some  cases  there  is  considerable  effusion  into 
the  ventricles  and  the  cavity  of  the  arachnoid,  but  in  others  there 
is  very  little  or  none.  Sometimes  there  is  evidence  of  determina- 
tion of  bK)od,  and  occasionally  small  patches  of  lymph  or  flocculi 
in  the  effused  fluid ;  rarely  the  brain  exhibits  evidence  of  slow 
inflammation. 

"The  nature  of  acute  hydrocephalus,"  says  Dr.  Bennet,  "has 
been  keenly  disputed,  and  whether  it  be  inflammatory  or  non- 
inflammatory, and  should  be  treated  with  antiphlogistics  or  nu- 
trients, will  be  found  to  be  discussed  at  great  length  in  systematic 
works  and  numerous  monographs.  The  fact  is,  that  the  group 
of  symptoms  indicating  the  occurrence  of  water  on  the  brain  is 
altogether  insufficient  to  prove  the  existence  of  this  morbid  pro- 
duct in  acute  cases.  What  we  observe  are  symptoms  of  excite- 
ment, gradually  passing  into  those  of  depression,  occasionally 
passing  into  paroxysms  of  pain,  restlessness  or  screaming,  alter- 
nately Avitli  drowsiness  and  coma.  These  symptoms  are  com- 
mon to  various  lesions  of  the  brain,  and  may  be  the  result  of 
congestion,  or  of  this  state  terminating  in  effusion  and  frequently 
in  exudation.  Hence,  why  sometimes  after  death  we  find  no 
lesion  whatever,  at  others  more  or  less  distension  of  the  ven- 
tricles with  serum,  and  very  commonly,  in  addition,  exudation 
at  the  base  of  the  cranium.  In  every  case,  the  symptoms  are 
referable  not  so  much  to  one  or  the  other  of  these  lesions  as  to 
something  which  they  all  have  in  common,  and  this  undoubtedly 
is  more  or  less  pressu^-e  on  various  portions  of  the  brain,  causing, 


392  DISEASES   OF   CHILDREN. 

first,  irritation  and  then  perversion  of  function,  or  so  operating 
as  to  excite  some  parts  and  to  depress  others.  In  the  great  ma- 
jority of  cases,  the  fluid  distending  the  ventricles  is  more  allied 
to  the  dropsies  than  exudations.  Nay,  even  when  lymph  is 
thrown  out  at  the  base  of  the  brain,  the  amount  of  serum  in  the 
ventricles  is  altogether  disproportioned  to  the  quantity  of  coagu- 
lated fibrin  deposited.  Hence,  I  am  disposed  to  think  that  even 
when  evidence  of  so-called  inflammation  exists,  still  the  fluid 
that  distends  the  ventricles  is  owing  to  a  mechanical  obstruction 
of  the  vessels,  causing  dropsical  efi'usion." 

Symptoms. — At  an  early  age,  we  find  the  disease  commencing 
as  an  obscure  remittent  fever,  the  languor,  or  more  properly 
stupor,  being  the  most  prominent  symptom.  The  fever  usually 
has  an  exacerbation  in  the  afternoon,  the  child  being  restless  and 
fretful  at  this  time.  Nausea  and  vomiting  are  very  frequently 
present,  especially  if  there  is  irritation  of  the  bowels,  forming 
one  variety  of  cholera  infantum.  In  a  longer  or  shorter  time, 
usually  not  more  than  from  two  to  ten  days,  the  patient  becomes 
almost  entirely  unconscious,  though  from  the  occasional  glance 
of  intelligence  it  is  not  believed  by  the  parents.  Still  it  is  rest- 
less and  uneasy,  turning  its  head  from  side  to  side,  putting  its 
hands  to  its  head,  and  uttering  those  sharp,  piercing  cries  indic- 
ative of  pain  ;  if  the  tongue  can  be  seen,  it  will  be  found  dry,  its 
tip  and  edges  red,  and  center  covered  with  a  white  coat.  The 
countenance  is  now  pallid  and  pinched  ;  the  eyes  want  expression, 
and  are  sunk  in  the  head,  the  pupils  generally  dilated;  the  head 
is  not  above  normal  temperature,  frequently  dry,  although  the 
forehead  is  covered  with  a  clammy  perspiration.  If  there  was 
not  diarrhoea  at  the  commencement,  there  is  now,  the  stools 
being  of  a  dirty-yellowish  or  greenish  color,  mixed  with  slimy 
matter  and  having  an  offensive  odor. 

A  very  common  grouping  of  symptoms  is  thus  reported  in  a 
clinical  case  by  Dr.  Bennet :  "Unconsciousness  of  surrounding 
objects,  not  recognizing  even  her  mother  ;  pupils  not  contractile 
to  light;  slight  strabismus  of  right  eye;  frequently  puts  her 
hands  to  the  head,  which  is  rolled  about  uneasily ;  continual 
grinding  of  the  teeth,  low  moaning,  and  occasioual  muttering. 
Tip  of  tongue,  which  is  all  that  can  be  seen,  very  dry  and  of  a 
scarlet  color;  loss  of  appetite;  constant  thirst  ;  vomiting;  invol- 
untary discharge  of  feces  and  urine ;  on    pressing   the  alnlomon 


ACUTE   HYDHOCEPHALUS.  393 

uneasiness  evidently  experienced,  and  moaning  increased;  skin 
hot  and  dry  ;  no  eruption ;  a  small  abscess  at  the  back  of  the 
neck,  with  a  sanious  discharge ;  action  of  the  heart  feeble  and 
fluttering;  pulse  one  hundred  and  forty,  small,  and  occasionally 
intermittent.  Breathing  short  and  hurried ;  no  rales."  These 
symptoms  were  developed  in  a  child  aged  six,  commencing  four- 
teen days  previously  with  diarrhoea. 

In  older  children  the  first  symptoms  will  be  a  more  or  less 
severe  headache,  with  intellectual  stupor,  the  child  being  restless 
and  uneasy,  and  passing  bad  nights ;  an  obscure  fever  may  be 
recognized  in  the  after  part  of  the  day,  the  skin  being  dry  and 
husky,  and  the  pulse  frequent  and  hard.  For  days,  and  even 
for  two  or  three  weeks,  the  symptoms  continue  in  this  way,  the 
child  being  occasionally  better  for  a  few  hours  or  sometimes  for 
a  day  or  two.  Suddenly  the  pain  in  the  head  becomes  intense ; 
the  face  is  pinched  and  expressive  of  great  suffering ;  the  tongue 
is  red  at  its  tip  and  edges,  dry,  and  its  center  covered  with  a 
white  coat ;  the  bowels  constipated,  or  there  is  diarrhoea  ;  urine 
scanty  ;  the  pupils  dilated,  and  immobile  on  exposure  to  light. 
The  child  does  not  like  to  be  disturbed,  is  constantly  dozing, 
though  its  nights  are  restless.  The  pulse  may  be  either  frequent 
and  sharp,  or  in  some  cases  slow  and  feeble.  Very  frequently 
there  is  nausea  and  vomiting,  sometimes  very  persistent  and 
intractable.  These  symptoms  becoming  very  severe,  deep  coma 
results,  from  which  the  child  never  recovers,  but  two  or  three 
days  elapsing  from  its  accession  until  the  fatal  termination. 

Diagnosis. — I  diagnose  this  disease  by  the  pinched  expression 
of  the  countenance,  every  part  seeming  to  be  contracted,  the 
dilatation  of  the  pupil,  the- stupor  and  at  the  same  time  restless- 
ness of  the  patient.  These  symptoms  may  be  confounded  with 
the  second  stage  of  inflammation  of  the  brain,  but  the  prior 
symptoms  are  usually  sufficient  for  the  diagnosis. 

Prognosis. — It  is  very  difficult  to  so  describe  this  disease, 
that  the  reader  may  determine  which  cases  will  recover,  and 
which  will  unavoidably  prove  fatal.  Usually,  if  the  child  is 
still  conscious,  and  there  is  not  such  marked  contraction  of  the 
countenance,  as  to  render  it  hippocratic,  we  may  hope  for  a 
favorable  result ;  if  the  contrary  is  the  case,  it  will  in  all  proba- 
bility prove  fatal. 


394  DISEASES   OF    CHILDREN. 

Treatment. — The  treatment  will  have  to  be  much  modified 
to  suit  each  individual  case;  yet  in  every  one  it  must  be  decidedly 
stimulant  and  sustaining.  If  there  is  continuous  nausea,  with 
evidence  of  morbid  accumulations,  the  stomach  should  be  re- 
lieved by  the  administration  of  a  prompt  emetic,  very  marked 
benefit  following  its  action.  In  other  cases  the  nausea  may  be 
arrested  by  a  sinapism  over  the  epigastrium,  and  the  administra- 
tion of  an  infusion  of  peach-tree  bark,  or  compound  powder  of 
rhubarb  and  potassa.  Injections  of  salt  and  water,  an  even  tea- 
spoonful  to  four  ounces  of  water,  will  sometimes  prove  very 
efficient  in  irritation  of  the  stomach  ;  chloroform  and  glycerine 
may  be  used  for  the  same  purpose,  and  may  afterwards  be  con- 
tinued in  doses  of  five  drops  every  hour  or  two,  for  its  stimulant 
and  at  the  same  time  soothing  influence.  If  there  is  diarrhoea, 
it  is  the  generally  received  opinion  that  it  should  be  checked  by 
the  use  of  astringents  ;  but  this  is  bad  practice,  as  almost  invari- 
ably on  the  arrest  of  the  discharges,  the  coma  becomes  complete, 
and  the  child  dies. 

Remedies  should  be  very  carefully  selected  in  these  cases. 
Aconite  and  Ipecac,  in  small  doses,  will  sometimes  quiet  irrita- 
tion of  the  stomach  and  relieve  this  irritation.  Gelseminum 
may  be  indicated  as  in  inflammation  of  the  brain.  Belladonna 
is  called  for  when  dullness  and  stupor  become  marked  symptoms. 
Rhus  will  sometimes  prove  a  most  valuable  remedy,  there  being 
a  sharp  frequent  pulse,  contraction  about  the  eyes  and  base  of  the 
brain,  sudden  startings  in  sleep  with  shrill  cry. 

With  the  relief  of  irritation  of  the  stomach,  and  to  a  certain 
extent  of  the  brain,  Apocynum  becomes  a  prominent  remedy, 
though  it  must  be  used  in  small  doses.  I^  Tinct.  Aconite  gtt.  iij., 
Tinct.  Apocynum  gtt.  v.,  water  5iv.;  a  teaspoonfnl  every  one  or 
two  hours.  If  indicated,  Rhus  or  Belladonna  should  be  substi- 
tuted for  the  Aconite. 

If  the  tongue  is  pallid  and  dirty,  sulphate  of  soda  should  be 
given  in  doses  of  two  to  five  grains  every  three  hours.  If  red 
and  dirty,  sulphurous  acid  will  be  the  remedy.  If  dry  and  harsh, 
the  child's  drink  may  be  acidulated  with  muriatic  acid,  or  it  can 
have  small  portions  of  good  sharp  cider,  or  in  some  cases,  of 
whey.  The  hot  mustard  foot-bath  will  be  sufficient  in  some 
cases,  if  thoroughly  used,  but  if  the  case  is  severe,  I  prefer  a  tub 
of  water  as  hot  as  the  child  can  bear  it,  and  rendered  stinii;- 
lant  by  the  addition  of  mustard  or  capsicum,  into  which  T  i)ut  tlie 


CHRONIC   HYDROCEPHALUS.  395 

child,  letting  it  remain  for  half  an  hour,  being  well  covered  with 
a  blunket.  In  place  of  this,  sponging  the  surface  with  hot  water, 
will  answer  a  good  purpose.  Dry  cupping  to  the  neck,  and 
even  sometimes  to  the  entire  spine,  is  among  our  most  important 
measures;  sometimes  the  cups  to  the  neck  maybe  scarified,  espe- 
cially if  there  is  much  heat  of  the  head.  A  sinapism  to  the  neck 
and  spine  will  sometimes  answer  the  purpose,  but  is  not  as  good 
as  the  cups,  and  I  think  not  as  useful  as  friction  with  strong  salt 
and  water  hot.  If  the  kidneys  fail  to  act  freely,  I  would  admin- 
ister an  infusion  of  hair-cap  moss  or  of  marsh-mallows,  with  a 
suitable  portion  of  acetate  of  potash  or  sweet  spirits  of  nitre. 

CHRONIC    HYDROCEPHALUS. 

Dropsy  of  the  brain  is  almost  exclusively  a  disease  of  child- 
hood, and  occurs  most  frequently  before  the  third  year.  It  is 
difficult  to  determine  the  causes  that  give  rise  to  the  effusion  of 
water  from  the  arachnoid,  but  as  it  occurs  almost  invariably  in 
children  of  feeble  vitality,  and  in  families  whose  children  die 
during  infancy  of  acute  hydrocephalus,  cholera  infantum,  or  this, 
we  are  led  to  believe  that  it  depends  upon  hereditary  debility. 
The  exciting  cause  may  be  the  exanthemata,  whooping  cough, 
disease  of  the  bowels,  or  inflammatory  disease,  or  it  may  arise 
from  depression,  produced  by  cold  and  other  causes. 

Symptoms. — The  symptoms  vary  very  greatly,  the  disease 
running  a  tolerably  rapid  course  in  some  cases,  and  a  very  slow 
one  in  others.  The  child  usually  complains  of  its  head,  if  it  can 
talk,  or  moves  it  from  side  to  side,  putting  its  hands  to  it  fre- 
quently. The  face  is  pallid  and  contracted,  or  in  some  cases  puffy 
and  without  expression ;  the  circulation  is  feeble,  the  extremities 
being  cold,  and  the  surface  easily  chilled  ;  the  appetite  is  irregu- 
lar, sometimes  good,  at  others  very  poor,  and  digestion  seems  to 
be  feeble ;  the  bowels  are  torpid  and  constipated,  though  some- 
times irregular.  As  the  disease  progresses,  we  notice  that  the 
child  is  very  stupid,  and  that  at  times  it  has  difficulty  in  con- 
trolling the  voluntary  muscles;  there  may  be  temporary  or  per- 
manent strabismus,  and  an  involuntary  rolling  about  of  the  eyes, 
with  a  dilated  and  fixed  pupil. 

Occasionally  we  observe  a  marked  irritability  of  the  stomach, 
that  is  with   difficulty  controlled,  and  in  some  cases  an  extreme 


396  DISEASES   OP   CHILDREN. 

irritability  and  restlessness,  though  the  intellectual  functions  are 
greatly  impaired.  As  the  disease  progresses  the  torpor  becomes 
deeper,  and  the  child  does  not  exhibit  the  symptoms  of  paiu 
above  named.  The  pulse  is  now  seen  to  be  getting  perceptibly 
weaker,  and  occasionally  irregular ;  the  hands  are  tremulous  and 
unsteady,  and  frequently  raised  to  the  back  of  the  head.  When 
the  child  sleeps,  its  eyes  are  half  open,  and  the  eyeballs  are  con- 
stantly moving  and  usually  drawn  upward.  When  the  torpor  is 
not  so  great,  the  child  is  in  some  cases  constantly  picking  its 
nose  or  lips,  and  is  extremely  irritable,  having  paroxysms  of 
rage  from  the  slightest  supposed  offense.  The  disease  may  con- 
tinue this  way  for  months,  or  in  some  rare  cases  for  years,  finally 
terminating  fatally  by  the  development  of  some  ataxic  disease, 
or  of  acute  hydrocephalus,  or  with  a  gradually  developed  maras- 
mus. 

Diagnosis. — In  very  young  children,  and  sometimes  up  to 
the  age  of  three  years,  there  will  be  found  a  perceptible  enlarge- 
ment and  distension  of  the  foutanelles,  and  separation  of  the 
sutures,  and  the  child's  head  is  appreciably  larger.  After  this,  we 
are  guided  entirely  by  the  general  symptoms  above  named. 

Prognosis. — The  prognosis  is  usually  unfavorable,  though 
some  cases  may  be  cured,  and  in  others  life  may  be  prolonged  for 
a  considerable  period.  Cases  are  recorded  in  which  the  persons 
lived  to  adult  age,  and  in  four  cases  to  twenty -seven,  thirty -two, 
forty-five  and  fifty-four  years. 

PosT-MoRTEM-ExAMiNATioN. — If  the  discasc  has  been  of  long 
duration,  the  bones  of  the  cranium  will  be  found  thin  and 
transparent,  and  occasionally  separated  from  each  other  by  very 
considerable  intervals.  The  effused  fluid  is  found  in  the  sac  of 
the  arachnoid,  and  in  the  ventricles;  if  in  the  ventricles  to  a 
great  extent,  the  convolutions  are  unfolded,  and  the  medullary  and 
cineritious  substances  can  with  difficulty  be  distinguished.  The 
brain  is  often  denser  than  usual,  and  is  not  diminished  in  weight. 

Treatment. — I  am  satisfied  that  the  greatest  success  in  the 
treatment  of  dropsy  will  follow  the  use  of  specific  remedies,  and 
especially  in  the  case  under  consideration.  The  remedy  I  prefer 
in  this  case  is  the  Apocynum  cannibinnm — its  substitute,  Aralia 
hispida.     I  prescribe  the  first  in  the  following  form  :     ^.  Tlnct. 


SPINAL   MENINGITIS.  397 

Apocynum  gtt.  x.,  water  5iv.;  give  a  teaspoonful  every  two  or 
three  hours.  The  Aralia  I  have  used  in  infusion,  associated  with 
the  tonics  named  below.  A  number  of  cases  of  hydrocephalus 
cured  by  Apocynum  are  on  record,  and  I  have  had  three  cases  in 
my  practice  which  have  recovered  under  its  use. 

After  the  use  of  these  means  for  some  days,  their  influence  in 
removing  the  accumulation  being  observed,  we  put  the  patient 
upon  the  use  of  tonics,  alternating  them. 

As  a  tonic,  some  of  the  preparations  of  hydrastia  answer  the 
best  purpose,  and  when  there  is  constipation  of  the  bowels,  may 
be  given  with  podophyllin  in  small  doses  ;  the  combination  of 
these  remedies  heretofore  given  may  be  employed.  The  Collin- 
sonia  canadensis  is  a  favorite  remedy  in  my  practice,  especially 
in  cases  where  there  is  irritation  of  the  nervous  system,  and  we 
may  associate  with  it  the  Ptelea,  Cornus,  Euonymus,  or  other 
remedies  of  this  class.  Rye  whiskey  and  cod-liver  oil  are 
excellent  when  the  stomach  bears  them  kindly,  and  should 
it  reject  the  oil,  its  place  may  be  supplied  by  sweet  cream  or 
beef-suet. 

The  child  should  have  a  daily  salt-water  bath  ;  sometimes  the 
entire  bath  will  be  best,  and  may  be  used  either  warm  or  cold, 
the  first  being  generally  preferable,  or  the  sponge-bath  may  be 
used  ;  in  either  case  it  should  be  followed  Avith  brisk  friction. 
The  child  should  be  taken  out  in  the  open  air  every  day,  being 
warmly  clad  in  flannel.  If  possible  it  should  be  removed  to  a 
high  locality  in  the  country,  where  it  can  have  pure  air  and  sun- 
shine, exercise  and  pure  milk. 

SPINAL    MENINGITIS. 

Inflammation  of  the  meninges  of  the  spinal  column  is  not  an 
uncommon  disease,  though  sometimes,  from  the  obscurity  of  its 
symptoms,  it  may  be  mistaken  for  other  affections.  It  occurs  in 
two  forms,  as  a  distinct  sporadic  inflammation,  and  as  an  epi- 
demic or  endemic  fever,  which  involves  the  spinal  cord.  It  is 
in  the  last  named  cases  that  mistakes  in  diagnosis  are  most  usu- 
ally made.  The  causes  of  this  affection  are  those  which  give 
rise  to  other  inflammations,  as  cold,  sudden  changes  of  tempera- 
ture, injuries,  and  especially  a  sudden  chilling  of  the  surface 
after  active  exertion.  It  occurs  most  frequently  in  the  young 
and  vigorous,  and  is  very  rare  after  middle  life. 


398  DISEASES   OF  CHILDREN. 

Symptoms. — Spinal  meningitis  usually  commences  with  a 
well-marked  chill,  lasting  for  several  hours,  though  sometimes 
with  a  severe  rigor  of  considerable  duration.  I  have  seen  cases 
in  which  the  chill  was  of  twenty-four  hour's  duration,  the  later 
part  of  it  being  alternated  with  flushes  of  heat.  Following  this 
there  is  marked  febrile  reaction,  with  hot,  dry  skin,  hard  and 
frequent  pulse,  tongue  coated  white,  the  edges  and  tip  being 
red,  constipation  of  the  bowels,  and  scanty  and  high-colored 
urine.  The  patient  complains  greatly  of  pain  in  the  back,  which 
is  so  increased  on  movement,  that  he  dislikes  to  change  his  posi- 
tion for  any  purpose ;  though  in  some  cases,  when  not  so  severe, 
they  are  constantly  shifting  their  position  to  give  them  ease. 
By  the  second  or  third  day  the  fever  usually  becomes  high, 
the  pulse  running  some  thirty  or  forty  beats  higher  than  in 
health,  the  skin  being  very  dry  and  constricted,  and  the  irrita- 
bility and  restlessness  marked.  These  symptoms  may  be  so  pro- 
minent as  to  completely  overshadow  the  symptoms  of  spinal  in- 
flammation, the  patient  not  even  complaining  of  pain,  unless  his 
attention  is  directly  called  to  it.  It  will  be  noticed,  however, 
that  the  slightest  movement  or  changing  the  position  of  the  body 
gives  rise  to  pain,  and  when  the  attention  is  thus  drawn  to  it  the 
soreness  of  the  spine  will  be  continually  noticed.  Deep  pressure 
usually  elicits  tenderness,  and  sometimes  the  sensibility  is  so  ex- 
quisite that  the  patient  cannot  bear  to  be  touched. 

As  the  disease  progresses,  the  fever  assumes  an  irritative  or 
typhoid  type.  The  tongue  soon  becomes  brown,  and  sordes  ap- 
pear on  the  teeth.  Typhomania  occurs  about  the  sixth  or  sev- 
enth day,  and  is  frequently  attended  with  looseness  of  the  bowels. 
Sometimes  there  is  marked  irritation  of  the  brain  and  delirium, 
at  others  a  stupor  which  soon  passes  into  deep  coma.  As  the 
local  disease  progresses,  it  is  found  that  the  lower  extremities  are 
subject  to  involuntary  movement,  and  that  the  patient  has  but 
partial  command  over  them  ;  and  that  the  bladder  and  rectum 
are  evacuated  without  the  knowledge  of  the  patient,  or  there  is 
retention  of  urine  without  the  power  of  discharging  it.  At  last, 
in  severe  cases,  paralysis  of  the  parts  below  the  seat  of  inHnmma- 
tion  is  complete.  The  fever  is  usually  continued,  though  some- 
times remittent,  and  is  invariably  ataxic,  presenting  well  marked 
typhoid  synij)toms,  with  the  exception  of  diarrhoea,  by  the  tenth 
to  the  twelftli  day.  It  is  usually  protracted,  lasting  from  two  to 
eight  or  ten  weeks. 


SPINAL,   MENINGITIS.  399 

Diagnosis. — We  d'lagnose  inflaramatiou  of  the  spinal  cord  by 
the  marked  tenderness  of  the  spine  and  inability  to  move,  the 
constant  pain  in  the  back,  with  the  severe  attendant  fever.  It  is 
almost  impossible  to  overlook  these  local  symptoms,  and  yet  in 
many  cases  they  have  been  disregarded,  to  the  great  detriment 
of  the  patient. 

Prognosis. — The  prognosis  is  usually  favorable,  if  treatment 
is  commenced  in  time,  but  is  unfavorable  after  it  has  made  prog- 
gress  for  several  days,  in  many  cases  terminating  fatally,  or  in 
paralysis. 

PosT-MoETEM  Examination. — In  some  cases  there  is  marked 
evidence  of  determination  of  blood  to  the  membranes,  and  en- 
largement of  the  vessels.  Sometimes  the  membranes  are  thick- 
ened, and  fragments  of  organized  lymph  on  the  free  surface  ; 
there  may  also  be  flocculi  in  the  fluid  of  the  spinal  cord,  which 
is  increased  in  quantity.  In  other  cases  the  disease  seems  to  be 
confined  to  the  pia-mater  and  the  substance  of  the  cord,  the  for- 
mer being  slightly  reddened,  and  sometimes  thickened,  and  the 
latter  softened,  sometimes  so  much  as  to  have  lost  all  traces  of 
organization. 

Treatment. — The  treatment  of  this  disease  will  vary  accord- 
ing to  the  indications.  In  some  cases  Aconite  or  Veratrum,  with 
Gelseminum,  will  be  the  remedy,  and  as  the  pulse  and  tempera- 
ture come  down,  we  find  the  symptoms  of  spinal  irritation  re- 
duced. In  other  cases  the  indications  for  Rhus  Avill  be  marked, 
and  it  will  be  associated  with  Aconite.  Bryonia  is  indicated  by 
the  steady  pain  in  the  spine,  with  possibly  a  flushing  of  the  right 
check.  Macrotys  will  be  indicated  by  mnscular  pain,  as  in  other 
cases ;  Sticta  by  the  pain  in  shoulders  and  neck  to  the  occiput ; 
Phytolacca  by  soreness  of  the  mouth  and  throat,  and  fullness  of 
cervical  glands. 

In  some  cases,  the  attack  being  sudden  and  severe,  and  the 
patient  sufiering  from  nausea  or  disgust  for  food,  drink,  or  medi- 
cine, we  find  a  full,  dirty  tongue,  and  conclude  that  the  treat- 
ment had  best  be  commenced  with  an  emetic.  The  Acetous 
Emetic  Tinctnre  acts  well,  but  in  many  cases  we  would  prefer 
Ipecac  in  doses  of  two  or  three  grains  every  fifteen  minutes  to 
free  cmesis.  With  a  broad,  pallid  and  dirty  tongue,  sulphite  of 
soda  will  be  indicated  in  the  usual  doses.  If  the  tongue  is  red, 
and  covered  with   a  glutinous  yellow  coat   (like  fecal  material) 


400  DISEASES   OF   CHILJ)REN. 

sulphurous  acid  is  the  remedy.  When  the  face  is  full  and  pur- 
plish, like  one  who  has  been  exposed  to  severe  cold,  Baptisiu  is 
given. 

When  the  temperature  is  high  we  may  sometimes  obtain  ex- 
cellent results  from  the  cold  wet-sheet  pack.  It  requires  a  little 
courage  to  use  it,  for  both  child  and  parents  are  afraid ;  still,  if 
we  have  a  severe  case,  and  the  stomach  is  irritable,  so  that  we 
do  not  see  our  way  clearly  with  other  remedies,  we  will  use  it. 
If  the  case  is  severe,  and  there  is  marked  impairment  of  the  skin 
with  exhaustion,  I  think  well  of  the  hot-blanket  pack.  In  place 
of  this,  rapid  sponging  of  the  surface  with  hot  water  answers 
well,  (it  should  be  done  before  a  fire,  and  the  surface  protected 
against  chill  by  a  blanket.)  Any  part  that  the  patient  complains 
of  may  be  thus  sponged. 

The  local  applications  to  the  spine  (if  we  use  any)  will  vary 
with  the  case.  Sometimes  dry  cups  give  relief.  In  other  cases 
hot  spongings,  or  hot  packs,  hot  bran,  or  a  bag  of  hot  salt,  to  tlie 
part,  is  of  benefit.  I  do  not  have  much  faith  in  liniments,  and 
am  inclined  to  believe  that  rest  is  better  than  the  rubbings. 

As  the  inflammation  passes  away  the  child  may  have  some  of 
the  simpler  bitters,  quinine  inunctions,  the  hypophasphites,  cod- 
liver  oil,  or  some  of  the  preparations  of  malt. 

CUKVATURE    OF    THE    SPINE. 

Curvature  of  the  spine  occurs  most  generally  in  the  young, 
and  is  rare  after  the  age  of  twenty-five.  In  all  cases  it  is  the 
result  of  enfeebled  vitality,  either  congenital  or  induced  by  des- 
titution, over  mental  exertion,  or  sexual  excitement.  In  sonic 
cases  this  manifests  itself  in  the  form  of  scrofula  or  tuberculosis, 
and  in  such  case  we  may  expect  disease  of  the  bones.  Two  va- 
rieties of  curvature  are  met  with,  lateral  and  posterior,  both  oc- 
curring most  frequently  in  the  dorsal  region,  though  at  last  always 
comi)ensated  by  curvature  of  the  lumbar  and  cervical  portions. 

Lateral  curvature  may  be  dependent  upon  affections  of  the 
muscles,  as  hypertrophy,  atrophy,  spasmodic  contraction  or 
inflammation  ;  upon  general  debility,  the  body  not  being  suffi- 
ciently strong  to  support  itself  in  the  erect  position  ;  upon  obli- 
quity of  the  pelvis,  the  result  of  injury  or  disease  of  the  lower 
extremities;  upon  altered  capacity  of  one  side  of  the  chest;  upon 
rachitis  or  softening  of  the  bones,  or  defective   dcvel()i)ment  of 


'•  CURVATURE  OF  THE  SPINE.  401 

the  vertebra.  Posterior  curvature  is  most  generally  dependent 
upon  disease  of  the  bodies  of  the  vertebra,  though  in  some  cases 
it  undoubtedly  results  from  debility,  and  the  habit  of  throwing 
the  head  and  shoulders  forward  in  sitting  and  walking ;  in  the 
last  case  being  very  mild.  Practically  we  have  to  study  the  case, 
first,  with  reference  as  to  whether  it  depends  upon  disease  of  the 
muscles  or  bones  ;  second,  whether  its  continuance  depends  upon 
determination  of  blood  or  upon  feeble  circulation;  and  third,  as 
regards  the  general  health,  whether  there  is  simple  debility  from 
imperfect  digestion  and  assimilation,  or  a  scrofulous  or  tubercu- 
lar cachexia.  The  success  of  the  treatment  will  depend  upon 
accurate  diagnosis  as  regards  these  points,  as  in  many  respects  it 
must  differ  in  different  cases. 

Symptoms. — The  symptoms  of  curvature  of  the  spine  vary 
greatly  in  different  cases,  in  some  being  very  marked,  and  in 
others  obscure.  Usually  the  child's  health  is  noticed  to' be  fee- 
ble, its  appetite  variable,  and  digestion  and  assimilation  imper- 
fect. It  may  or  may  not  complain  of  pain  in  the  back,  but  it 
will  be  noticed  that  the  back  is  weak,  and  that  it  makes  unusual 
efforts  to  rest  it.  In  lateral  curvature,  the  disease  is  most  usu- 
ally dependent  upon  local  debility  of  the  erector  muscles  of  the 
spine,  and  there  is  frequently  no  complaint,  except  from  weak- 
ness of  the  back,  and  the  symptoms  of  general  debility  above 
named.  If  partially  owing  to  spasmodic  action,  pain  would  be 
a  constant  attendant,  though  usually  there  would  be  no  tender- 
ness on  pressure.  If  the  result  of  disease  of  the  bones,  as  in 
most  cases  of  posterior  curvature,  in  addition  to  more  or  less 
pain,  there  will  be  tenderness  on  deep  pressure.  Ijn  these  cases 
the  disease  of  the  bone  causes  irritation  of  the  spinal  cord,  and 
we  have  the  symptoms  heretofore  named. 

Diagnosis. — An  examination  of  the  spine  will  determine 
the  existence  of  curvature,  and  it  is  usually  not  difficult  to  de- 
termine which  is  the  primary  and  which  is  the  curvature  of  com- 
pensation. In  almost  all  cases  of  lateral  curvature  we  will  find 
the  fault  to  exist  principally  in  the  muscles  at  first,  though  as 
the  disease  progresses,  irritation  is  frequently  developed,  result- 
ing in  spasmodic  action,  and  finally  in  atrophy  or  softening  of 
the  bones;  hence  spinal  tenderness  will  usually  result  in  the  lat- 
ter part  of  the  disease,  and  not  at  is  commencement.  In  poste- 
26 


402  DISEASES  OP   CHILDREN.  * 

rior  curvature,  we  sometimes  have  the  most  marked  evidence  of 
scrofulous  cachexia,  and  in  most  cases  we  have  marked  general 
debility.  It  will  be  recollected  that  the  disease  of  the  bodies  of 
the  vertebra  may  be  a  true  inflammation,  or  result  from  deposit 
of  tubercles  aud  scrofulous  material,  or  may  be  simple  softening 
from  rachitis.  In  the  first  case  the  pain  will  be  marked  and  de- 
cided, in  the  second  there  is  simple  irritation  aud  aching  of  the 
part,  with  tenderness  on  pressure ;  and  in  the  last  we  will  have 
the  previous  curvature  and  deformity  of  the  legs  and  pelvis,  in 
addition  to  the  absence  of  pain  and  tenderness,  to  aid  us  in  the 
diagnosis.  Mr.  Solly  believed  that  softening  of  the  bones  might  be 
entirely  local,  and  might  be  dependent  upon  nervous  exhaustion  ; 
in  such  case  the  symptoms  would  be  obscure. 

Prognosis. — In  lateral  curvature  a  favorable  prognosis  may 
be  given  in  many  cases,  the  deformity  being  nearly  entirely  re- 
niovedj  or  it  maybe  simply  arrested,  the  body  so  accommodating 
itself  to  it  as  to  give  rise  to  but  little  subsequent  trouble.  In 
]K)sterior  curvature  the  best  results  usually  obtainable  is  to  stop 
the  disease  and  prevent  further  curvature.  It  is  true  that  in 
some  cases  we  may  partially  correct  tiie  deformity,  but  in  a  large 
majority  the  attempt  is  attended  with  injury  rather  than  benefit. 
If  there  has  been  destruction  of  the  bodies  of  the  vertebra  the  best 
result  is  anchylosis  of  the  bones  and  of  course  permanence  of  the 
curvature;  and  if  this  is  prevented  by  instruments  for  extension, 
the  life  of  the  patient  will  almost  surely  be  sacrificed. 

Treatment. — In  all  forms  of  spinal  curvature  attention  to 
the  general  health  is  one  of  the  most  important  points  in  the 
treatment.  Those  bitter  tonics  that  improve  the  tone  of  the 
stomach,  and  give  the  patient  a  good  appetite  and  power  of  di- 
gestion are  applicable.  For  the  selection  of  these  remedies,  the 
reader  is  referred  to  the  first  part  of  this  work,  "restoratives," 
which  will  enable  him  to  select  the  best  remedy.  If  there  is 
disease  of  the  bones  assuming  the  form  of  softening,  phosphoric 
acid  has  been  recommended;  and  from  the  little  experience  I 
have  had  with  it,  I  am  inclined  to  believe  that  it  will  generally 
be  found  advantageous;  we  would  commence  its  administration 
in  doses  of  two  drops  of  the  dilute  acid,  four  or  five  times  a  day, 
and  increase  it  if  deemed  best.  Phosphate  of  soda  may  be  given 
with  the  food  in  such  quantities  as  will  keep  the  bowels  soluble. 


CURVATURE  OF  THE  SPINE.  403 

Simple  lime  water  is  sometimes  useful,  and  children  will  improve 
wheu  it  is  added  to  their  milk.  Even  common  salt  becomes  an 
important  remedy  when  children  have  not  had  it  in  sufi&cient 
quantity  (bottle  babies),  and  added  to  their  milk  there  is  a  deci- 
ded improvement.  Hypophosphite  of  lime,  the  compound  syrup 
of  the  hypophosphites,  and  some  of  the  phosphates,  may  also  be 
thought  of.  Occasionally  veratrum  and  arsenic  in  small  doses 
will  improve  the  appetite,  digestion  and  bloodmaking. 

When  the  symptoms  would  lead  us  to  believe  there  was  scrof- 
ulous disease  of  the  bones,  the  vegetable  alteratives  may  be 
brought  into  requisition.  A  combination  of  yellow  dock  and  tag 
alder,  with  small  portions  of  acetate  of  potash  has  answered  my 
purpose  well.  If  there  is  great  irritability  of  the  nervous  system 
I  would  substitute  the  bromide  of  ammonium  for  the  prepara- 
tions of  potassa.  These  remedies  should  not  take  the  place  of 
tonics  and  restoratives,  but  should  be  associated  with  them  in 
such  manner  as  that  normal  digestion  and  assimilation  shall  be 
the  first  object  in  view.  A  nutritious  and  easily  digeste4  diet 
should  be  prescribed,  and  frequently  a  small  amount  of  malt 
liquor  is  advisable.  The  sponge  bath  should  be  used  daily, 
sometimes  of  simple  water,  salt  and  water,  or  stimulants,  as  cap- 
sicum or  mustard,  or  the  mineral  acid  baths,  or  of  a  decoction  of 
the  bitter  tonics  and  astringents. 

If  there  is  simple  loss  of  muscular  power,  as  in  many  cases  of 
lataral  curvature  we  would  recommend  open  air  exercise,  and  fric- 
tion of  the  spine  with  cold  salt  water,  and  sometimes  the  use  of  elec- 
tricity. These  are  the  only  cases  in  which  exercise  is  permissible, 
and  tlien  it  should  be  so  regulated  as  not  to  prove  exhaustive. 
Sir  B,  Brodie  recommends  that  the  muscles  of  the  back  be  strength- 
ened by  climbing  and  other  exercises,  for  which,  in  delicate  girls, 
friction  or  shampooing  for  an  hour  or  two  daily  might  be  sub- 
stituted ;  and  the  patient  should  lie  down  for  a  part  or  a  whole 
of  the  time  she  was  not  engaged  in  exercise.  Mechanical  support 
may  be  used  in  these  cases,  but  it  should  always  permit  free 
movement.  If  in  any  case  there  is  irritation  and  pain,  with  ten- 
derness on  pressure,  the  child  should  maintain  the  recumbent 
position,  and  especially  is  this  the  case  in  posterior  curvature. 
Rest  is  all-important  in  these  cases,  until  the  disease  is  entirely 
arrested,  and  though  it  will  sometimes  seem  as  if  the  child  could 
not  bear  the  continued  confinement,  we  will  find  that  it  absolute- 
ly improves  in  every  respect,  while  maintaining  the  most  perfect 


404  DISEASES   OF    CHILDEEN. 

quiet.  Counter-irritation  is  of  much  importance  in  these  cases, 
but  we  must  be  careful  not  to  carry  it  so  far  as  to  unduly  irritate 
the  nervous  system,  or  induce  debility  by  the  excessive  discharge. 
The  irritating  plaster  is  a  favorite  application,  and  will  usually 
be  found  the  best  of  any.  It  may,  in  severe  cases,  be  replaced 
by  the  issue,  and  in  others  by  two,  three  or  four  small  setons,  as 
common  surgeons'  silk,  passed  through  a  fold  of  the  skin  on 
each  side  of  the  spine. 

In  cases  of  the  diseases  of  the  bones.  Dr.  Pirrie  remarks, 
"That  any  attempt  to  remove  the  curvature  would  be  injudicious. 
Anchylosis  is  the  only  favorable  termination  to  be  hoped  for,  and 
therefore  the  object  to  be  aimed  at  in  treatment  should  be  to 
place  the  patient  under  circumstances  most  likely  to  conduce  to 
that  result.  With  that  view,  it  is  indispensable,  first  to  keep 
the  patient  in  a  recumbent  position,  so  as  to  remove  from  the 
diseased  parts  the  pressure  of  the  superimposed  weight,  and  to 
preserve  the  parts  in  a  state  of  perfect  quietude  in  that  position ; 
and  secondly,  to  use  all  means,  judicious  and  available  in  the  cir- 
cumstances of  the  case,  for  maintaining  the  general  health.  One 
particular  advantage  which  results  from  preserving  the  parts  at 
rest  in  the  horizontal  position,  is  that  the  removal  of  the  irrita- 
tion caused  by  the  superincumbent  weight  from  the  diseased 
parts  diminishes  the  danger  of  the  formation  of  abscess,  which  is 
a  most  unpromising  occurrence,  and  must  induce  the  gloomiest 
apprehensions  as  to  the  ultimate  result." 

A  most  excellent  means  of  attaining  perfect  rest  is  aiforded 
by  a  common  camp  cot,  with  the  head  elevated  about  a  foot, 
and  covered  with  a  soft  hair  mattress ;  two  crutches  softly  padded, 
should  pass  from  the  foot  up  to  the  arm-pits,  and  an  india-rubber 
webbing  attached  to  the  arms  of  these  to  support  the  trunk.  In 
this  apparatus  there  is  constant  gentle  extension ;  the  body  is 
supported  by  the  webbing,  the  patient  lying  on  the  back,  or  face 
downward,  as  seems  best  suited  to  the  case.  For  full  description 
the  reader  would  do  well  to  consult  Bigg  on  Deformities,  the 
second  volume  containing  most  explicit  descriptions  of  apparatus 
and  well-drawn  wood-cuts. 


EPILEPSY.  405 

EPILEPSY. 

Epilepsy  is  one  of  the  most  serious  of  the  diseases  of  the  nerv- 
ous system,  not  because  of  its  fatality,  for  it  runs  a  very  chronic 
course,  but  because  there  is  no  tendency  to  spontaneous  arrest, 
and  medicine  has  heretofore  had  very  little  influence  upon  it. 
One  of  the  most  distressing  features  of  the  disease  is,  that  it  grad- 
ually impairs  the  mind,  until  the  person,  once  bright  and  of 
sound  mind,  becomes  a  driveling  idiot  or  a  raving  maniac. 
The  disease  usually  commences  in  childhood,  most  frequently  be- 
tween the  ages  of  six  and  twelve. 

The  causes  of  epilepsy  are  various,  and  not  very  well  under- 
stood. They  may  be  divided  into  intrinsic  and  extrinsic,  in  the 
first  case  existing  in  the  cerebro-spinal  nervous  centers,  or  their 
immediate  surroundings,  and  in  the  second  existing  at  a  distance, 
and  affecting  the  spinal  cord  through  the  nerves.  Of  the  first, 
we  may  instance  inflammation  and  determination  of  blood  to  the 
cerebro-spinal  centers,  disease  of  the  meninges  and  of  the  bow- 
els, and  injuries  of  the  bones,  giving  rise  to  compression  ;  or  con- 
tinued irritation,  as  by  the  presence  of  a  spicula  pressing  the 
nerve-substance.  Derangements  of  the  blood  may  sometimes 
give  rise  to  epilepsy,  as  in  the  retention  of  the  solids  of  the  urine 
and  other  changes  that  we  are  not  cognizant  of.  By  an  extrinsic 
cause,  we  understand  one  in  which  the  irritation  being  set  u^)  at 
a  distance  is  propagated  along  the  nerve  trunks  to  the  spinal 
cord,  where,  setting  up  an  irritation,  it  manifests  itself  through 
the  excito-motory  system  of  nerves.  The  most  simple  instance 
of  this  action  is  witnessed  in  the  case  of  cramps  of  the  muscles  of 
the  extremities  from  irritation  of  the  intestinal  canal,  as  in 
cholera  morbus,  and  in  the  case  of  infantile  convulsions  from 
teething  or  from  gastro-intestinal  irritation.  Epilepsy  n^ay  in 
this  way  arise  from  irritation  of  the  stomach  from  crude  indiges- 
tible food,  from  worms,  from  irritation  of  the  bowels,  the  kid- 
neys, or  bladder,  or  genital  organs.  The  cause  being  sufficient 
to  set  the  disease  going,  may  disappear  entirely  in  a  few  days  or 
weeks,  and  yet  the  epileptic  attacks  continue.  It  would  seem 
that  when  this  abnormal  action  is  once  set  up,  the  tendency  to 
its  continuance  is  the  same  as  in  healthy  functions;  but  why  this 
is  we  kno^v  not,  and  neither  can  we  give  any  probable  theory. 

As  regards  the  pathology  of  epilepsy,  we  are  much  in  the  dark. 


406  DISEASES   OF   CHILDREN. 

In  some  cases  it  would  seem  to  be  dependent  on  a  too  free  circu- 
lation of  blood  in  the  nervous  centers — determination  of  blood; 
in  other  cases  upon  a  sluggish  circulation — congestion;  and  in 
still  others,  upon  some  defect  in  nutrition.  There  are  cases  in 
which  it  is  very  manifest  that  the  condition  of  the  blood  is  the 
exciting  cause  of  the  epileptiform  seizure,  though  we  must  still 
imagine  an  unnatural  irritability  of  the  nerve  centers  to  be  so 
impressed.  Thus,  I  have  seen  cases  in  which  every  convulsion 
was  preceded  by  deficient  secretion  of  urine ;  and  so  long  as  this 
secretion  could  be  maintained  in  the  normal  condition,  so  long 
would  the  patient  be  free  from  its  seizure.  Cases  in  which  the 
disease  is  dependent  upon  the  amount  and  character  of  the  men- 
strual discharge,  have  come  under  the  notice  of  almost  every 
one.  Experience,  however,  has  proven  to  me,  that  epilepsy  is 
eminently  a  disease  of  debility  of  the  nervous  system,  even  in 
cases  in  which  there  seems  to  be  the  most  evident  symptoms  of 
irritation  and  determination  of  blood. 

Dr.  Radcliffe  has  written  a  most  interesting  paper  op  the 
pathology  of  convulsions,  and  draws  the  following  conclusions: 
"1st.  The  epileptic  and  epileptiform  paroxysm  is  not  unfre- 
quently  preceded  by  signs  of  defective  respii'ation.  2d.  It  is 
usually  accompanied  by  a  state  of  unmistakable  suiFocation.  3d. 
The  condition  of  respiration  during  convulsion  is  one  which 
supports  the  notion  that  the  convulsion  is  connected  with  de- 
pressed and  not  with  exalted  vital  action.  4th.  In  the  chronic 
form  of  convulsive  disorders,  the  inter-paroxysmal  condition  is 
usually  marked  by  evident  signs  of  feeble  circulation.  5th.  The 
epileptic  and  epileptiform  paroxysm  is  usually  if  not  invariably 
preceded  by  signs  of  failure  in  the  circulation.  6th.  In  the  fully 
developed  paroxysm,  the  pulse  is  sometimes  aroused  to  a  con- 
siderable degree  of  activity,  not  because  the  arteries  are  receiving 
a  largely  increased  supply  of  red  blood,  but  because  they  are 
then  laboring  under  a  load  of  black  blood,  as  they  are  found  to 
labor  during  suffocation.  7th.  Convulsion  is  never  co-incident 
with  a  state  of  active  febrile  excitement  of  the  circulation.  8th. 
Epileptiform  convulsion  is  a  direct  consequence  of  sudden  and 
copious  loss  of  blood.  9th.  The  condition  of  the  circulation 
during  convulsion  is  one  which  supports  the  notion  that  the 
convulsion  is  connected  with  depressed  and  not  with  exalted 
vital  action." 


EPILEPSY.  497 

It  is  of  but  little  use  to  try  to  study  the  original  cause  in  many 
cases  of  epilepsy,  for  as  has  been  remarked,  it  has  possibly 
passed  away  months  before  our  examination.  There  is  always, 
however,  an  exciting  cause,  which  it  is  necessary  to  determine,  if 
possible,  as  upon  its  removal,  the  success  of  our  treatment  will 
in  great  measure  depend.  I  have  known  it  to  be  a  failure  of 
excretion,  an  imperfection  in  digestion,  derangement  of  the 
menstrual  function,  excessive  mental  emotion,  and  not  unfre- 
quently  excessive  sexual  excitement. 

Symptoms. — In  some  cases  there  are  brief  premonitory  symp- 
toms of  the  approaching  seizure,  and  ra»ely,  the  patient  has  no- 
tice of  it  for  hours.  The  sensations  differ  in  different  cases : 
sometimes  a  sense  of  weight  and  oppression  in  the  head,  with 
giddiness  and  loss  of  voluntary  power ;  in  others,  a  coldness  pass- 
ing from  the  feet  upwards,  and  terminating  in  the  epileptic  seiz- 
ure when  it  reaches  the  head.  In  the  more  protracted  cases, 
there  is  usually  a  marked  dullness  and  hebetude,  noticed  by  the 
friends,  and  the  patient  feels  a  loss  of  consciousness  that  is  very 
unpleasant. 

In  an  attack  of  epilepsy  the  patient  becomes  suddenly  uncon- 
scious and  falls  to  the  floor,  or  wherever  he  may  be  situated. 
Involuntary  movement  from  spasmodic  contraction  and  relaxa- 
tion, is  characteristic  of  the  disease,  and  may  be  very  intense  or 
mild.  If  severe,  the  limbs  are  thrown  in  various  positions,  the 
trunk  contorted,  and  the  features  remarkably  changed.  First 
one  group  of  muscles  contract  and  then  another,  so  that  parts 
are  kept  in  constant  movement.  The  lower  jaw  and  tongue  be- 
ing also  affected,  we  find  that  usually  the  latter  organ  is  severely 
bitten,  if  means  are  not  taken  to  avoid  it.  The  patient  usually 
froths  at  the  mouth ;  respiration  is  normal  in  frequency,  and  the 
pulse  but  little  changed,  except  that  it  is  smaller  and  feebler. 
The  countenance  is  not  only  distorted  by  the  convulsion,  but  in 
some  cases  is  turgid  and  purplish,  or  almost  black.  Frequently 
the  urine,  and  sometimes  the  feces,  are  passed  involuntarily  dur- 
ing its  continuance. 

The  duration  of  the  epileptic  seizure  is  very  variable,  some- 
times lasting  but  a  few  seconds,  and  at  others  for  fifteen  or  twenty 
minutes.  The  patient  may  have  but  one  attack  at  a  time,  or 
they  may  succeed  one  another  at  short  intervals,  until  quite  a 
large  number  have  passed.     When  the  attack  ceases,  the  patient 


408  DISEASES   OF   CHILDREN. 

becomes  completely  relaxed,  and  usually  falls  into  a  deep,  coma- 
tose sleep,  from  which  it  is  almost  impossible  to  arouse  him  for 
an  hour  or  two.  The  frequency  of  their  recurrence  varies  in 
different  cases;  in  some  they  do  not  appear  oftener  than  once  a 
month  ;  in  others  every  week,  or  almost  every  day.  Sometimes 
they  are  so  distinctly  periodic  that  the  return  can  be  closely  cal- 
culated, but  at  others  they  are  very  erratic  in  their  course.  In 
many  cases  there  are  slight  seizures  during  the  intervals  between 
the  principal  attacks ;  in  these  the  patient  seems  to  lose  conscious- 
ness for  but  a  moment,  and  stares  vacantly  at  persons  present; 
passing  off,  he  has  no  recollection  of  it,  nor  of  the  epileptic 
attack.  » 

Diagnosis. — We  diagnose  epilepsy  from  apoplexy  by  the  fact 
that  in  the  first  there  is  continual  spasmodic  action,  while  in  the 
last  there  is  not  the  slightest  motion  ;  in  the  one  there  is  frothing 
at  the  mouth,  in  the  other  it  occurs  but  rarely ;  in  apoplexy  the 
respiration  is  slow  and  stertorous,  and  the  pulse-  full  and  slow, 
while  in  epilepsy  respiration  is  of  usual  frequency  without  ster- 
tor,  and  the  pulse  is  small  and  frequent.  We  diagnose  it  from 
hysteria  by  the  previous  history  of  the  case,  and  by  the  fact  that 
we  are  able  to  determine  that  there  is  not  complete  loss  of  con- 
sciousness in  the  latter  case. 

Prognosis. — So  far  as  regards  the  cure  of  the  disease,  the 
prognosis  is  unfavorable,  unless  the  means  here  recommended 
prove  more  serviceable  than  those  heretofore  used.  But,  as  be- 
fore remarked,  it  runs  a  course  of  years,  and  the  patient  dies 
finally  of  some  other  affection  in  a  great  many  cases. 

PosT-MoRTEM  Examination. — In  a  majority  of  cases  the 
scalpel  reveals  no  lesion  to  account  for  the  severe  disturbance  of 
the  system  during  life,  and  what  lesions  are  found  generally  have 
no  relation  to  the  epileptic  affection.  In  some  cases  the  evidence 
of  slow  inflammatory  action  is  found  in  the  brain  or  spinal  cord, 
or,  in  rare  cases,  a  morbid  growth  in  the  nervous  substance,  or 
from  the  meninges  or  bones,  is  observed,  and  in  others  a  change 
of  structure,  usually  softening,  has  occurred.  These,  however, 
form  but  a  small  fraction  of  the  cases.  In  other  instances  some 
organ,  as  the  stomach,  kidneys,  uterus,  etc.,  is  found  diseased, 
and  as  the  epilepsy  made  its  first  appearance  with  the  symptoms 
of  tliese  diseases,  we  have  good  reasons  to  believe  that  they  acted 
as  exciting  causes. 


EPILEPSY.  409 

Treatment. — The  treatment  in  these  cases  is  of  two  kinds : 
that  for  the  arrest  of  the  paroxysm,  and  that  for  the  radical  cure 
of  the  disease.  If  called  to  see  a  person  suffering  from  an  attack 
of  epilepsy,  we  would  place  the  patient  in  such  a  position  that 
he  would  not  be  likely  to  injure  himself,  and  if  the  convulsive 
action  was  severe,  get  a  friend  to  hold  a  cork  or  piece  of  soft 
wood  between  the  teeth  to  prevent  biting  the  tougne.  Usually 
this  is  all  that  is  necessary,  except  in  cases  where  the  patient  has 
a  succession  of  attacks.  In  these  cases,  as  soon  as  the  first  par- 
oxysm commences  passing  off,  we  may  administer  the  compound 
tincture  of  Lobelia  and  Capsicum  in  half-teaspoonful  doses  every 
five  or  ten  minutes,  until  nausea  is  induced,  which,  in  a  large 
majority  of  cases,  will  prevent  a  return  of  the  convulsion ;  or 
we  may  use  the  tincture  of  Gelseminum  for  the  same  purpose, 
giving  it  in  doses  of  from  ten  to  twenty  drops,  or  even  half  a 
drachm  of  the  common  tincture,  every  ten  or  fifteen  minutes,  un- 
til the  full  relaxant  influence  of  the  remedy  is  produced.  A  com- 
bination of  sulphuric  ether,  liquor  ammonia,  and  tincture  of  asa- 
foetida  may  be  used  for  the  same  purpose,  but  it  is  not  as  efficient 
as  the  preceding  measures.  If  need  be,  stimulant  applications 
may  be  made  to  the  lower  extremities  and  to  the  spine,  but  usu- 
ally this  is  not  necessary. 

As  regards  a  radical  cure,  we  may  attempt  it  in  all  cases  in 
which  there  is  no  structural  lesion  of  the  spinal  cord  or  brain,  or 
their  enclosures,  to  account  for  the  disease.  If  there  is,  the  case 
becomes  one  for  the  surgeon  rather  than  the  physician,  though 
operations  thus  far  have  proven  very  unsuccessful.  If  we  can 
detect  any  lesion  of  function,  especially  if  it  seem  to  bear  a  rela- 
tion to  the  epileptic  seizure,  we  would  employ  remedies  for  its 
removal.  Thus,  in  rare  cases,  a  cure  will  result  from  the  removal 
of  worms,  and  relief  of  irritation  of  the  intestinal  canal ;  from  the 
relief  of  menstrual  irregularity;  by  establishing  and  maintaining 
free  secretion  of  the  kidneys,  when  functional  lesion  of  these 
organs  has  been  prominent,  etc.  In  some  cases  the  disease  ap- 
pears to  be  dependent  upon  spinal  irritation  and  determination 
of  blood,  and  occasionally  a  cure  may  be  effected  by  the  use  of 
the  irritating,  plaster  to  the  spine,  the  administration  of  tincture 
of  Gelseminum  and  the  use  of  those  other  measures  recommended 
under  the  head  of  spinal  irritation.  Belladonna,  ergot,  and  nux 
vomica  may  be  used  when  there  seems  to  be  feeble  circulation 
in  the  nervous  substance  and  tendency  to  congestion,  manifested 


410  DISEASES   OF   CHILDREN. 

by  symptoms  of  paralysis,  or  a  feeliug  of  deaduess,  coldness,  or 
tingling  as  if  the  part  were  asleep. 

In  a  large  majority  of  cases,  however,  there  is  no  lesion  that 
would  seem  sufficient  to  occasion  the  epileptic  seizure ;  and  even 
where  there  is,  and  we  have  removed  it,  and  restored  all  the 
functions  of  the  system,  the  nervous  disease  will  still  continue. 
Here  our  treatment  will  be,  to  a  great  extent,  empirical ;  it  is 
true  we  correct  all  lesions  of  function,  and  try  to  get  the  sys- 
tem in  as  healthy  a  condition  as  possible,  but  after  this  we  give 
remedies  simply  because  they  have  proven  efficient  in  other 
cases.  I  have  employed  the  bromide  of  ammonium  in  my  prac- 
tice, with  the  most  marked  success,  sometimes  using  it  alone, 
^xid  at  others  in  combination  with  other  remedies.  I  prescribe 
it  in  the  proportion  of  half  an  ounce  of  the  salt  to  four  ounces  of 
water,  of  which  the  dose  is  half  a  teaspoonful  four  or  five  times 
a  day.  If  we  are  to  expect  success,  the  remedy  must  be  perse- 
vered with,  and  if  the  quantity  named  is  not  sufficient,  it  should 
be  increased  to  such  an  extent  as  to  hold  the  paroxysms  in 
check.  After  twenty  years  experience,  I  can  still  recommend 
the  bromide  of  ammonium,  especially  in  early  life,  having  cured 
scores  of  cases  with  it.  Do  not  substitute  bromide  of  potash 
for  it,  for  this  remedy  has  a  widely  different  field.  If  the  patient 
is  stout,  has  a  vigorous  circulation,  and  suffers  from  excitement 
of  the  reproductive  organs,  bromide  of  potassium  is  the  remedy. 
Some  most  persistent  cases  have  yielded  to  this  treatment,  and  I 
am  in  hopes  that  it  will  prove  curative  in  many  of  these  distress- 
ing cases. 

All  undue  excitement  must  be  avoided  in  epilepsy,  the  sufferer 
leading  the  most  regular  life.  Some  employment  should  be  fur- 
nished that  would  amuse  the  mind,  and  keep  it  normally  active, 
but  much  mental  exertion  is  injurious  ;  novel  reading,  or  any- 
thing in  which  the  mind  becomes  deeply  absorbed,  proves  hurt- 
ful. Above  all  things  else,  excessive  sexual  excitement  is  most 
injurious,  either  as  solitary  vice  or  irritation  of  the  organs  from 
disease,  and  it  will  become  the  practitioner's  duty  to  examine 
into  the  case  with  reference  to  this  matter,  and  give  the  neces- 
sary advice  and  treatment. 


CONVULSIONS.  411 

CONVULSIONS. 

Convulsions  occur  far  more  frequently  during  childhood  than 
after  puberty,  though  they  may  be  occasionally  noticed  at  all 
ages.  The  causes  giving  rise  to  them  are  various.  Sometimes 
they  are  produced  by  disease  of  the  brain  and  spinal  cord,  as  in 
determination,  inflammation,  and  some  obscure  structural  lesions; 
at  others  they  arise  from  an  external  irritation,  it  being  trans- 
mitted to  the  spinal  cord,  and  giving  rise  to  excited  reflex  action. 
According  to  Dr.  Marshall  Hall,  convulsions  are  dependent  upon 
irritation  of  the  true  spinal  system,  and  though  this  occurs  in 
some  cases  from  causes  acting  directly  upon  the  nervous  system, 
it  more  frequently  depends  upon  an  irritation  of  some  distant 
part  transmitted  to  the  spinal  cord  through  the  nerves.  Thus, 
we  find  convulsions  arising  in  this  way  during  dentition,  from 
crude  or  acrid  ingesta,  from  irritation  of  the  stomach  or  bowels, 
from  the  irritation  produced  by  worms,  and  from  inflammation 
of  internal  organs,  or  disease  of  the  surface,  attended  with  great 
irritation  and  pain. 

Symptoms. — If  convulsions  occur  during  disease,  they  are 
generally  preceded  by  tolerably  well-marked  symptoms,  by  which 
the  close  observer  may  anticipate  their  approach ;  and  though 
not  always  constant  it  is  well  to  give  them  due  consideration. 
The  most  marked  of  these  is  a  sudden,  jerking,  involuntary 
movement  of  the  extremities,  and  quick  grasping  movement  of 
the  hands.  This  will  be  observed  as  well  when  the  child 
sleeps  as  when  awake,  and  is  sometimes  increased  by  motion. 
Usually  the  child  sleeps  with  its  eyes  partly  open,  and  we  ob- 
serve that  the  globe  of  the  eye  is  drawn  upward  and  rolled 
about,  and  this  involuntary  movement  of  the  eye  may  be  fre- 
quently noticed  when  awake.  With  these  symptoms  there  may 
be  excitement  of  the  nervous  system,  manifested  by  restlessness, 
fits  of  crying  in  children,  and  sleeplessness  ;  or  we  may  have  the 
reverse,  the  patient  being  dull,  impassible  and  somnolent. 

The  attack  is  always  sudden,  the  patient  losing  consciousness, 
and  being  to  a  great  extent  insensible.  The  convulsion  is  usu- 
ally very  marked,  but  in  some  cases  we  find  it  slight  or  entirely 
absent,  the  patient  being  rigid  and  remaining  in  one  position. 
Respiration  is  labored,   in  many  cases  very  markedly  so,  and  in 


412  DISEASES   OF    CHILDEEN. 

these  the  countenance  is  turgid  and  purple,  and  the  features 
distorted.  The  pulse  is  very  frequent  and  small,  or  it  is  soft, 
feeble  and  small,  and  but  little  increased  in  frequency.  In  the 
severer  cases,  deglutition  is  almost  impossible,  and  from  the  fall- 
ing backward  of  the  tongue  respiration  is  snoring.  These  symp- 
toms may  continue  for  a  moment  or  two  to  fifteen  minutes,  or 
half  an  hour,  in  the  milder  cases  terminating  in  a  return  of  con- 
sciousness, but  the  severer  in  a  deep  sopor,  from  which  the 
patient  can  not  be  aroused.  One  convulsion  may  terminate  the 
attack,  but  in  many  cases  one  succeeds  another  for  from  one  to 
twenty-four  hours.  The  interval  between  the  spasms  is  fre- 
quently marked  by  nothing  more  than  a  relaxation  of  the  entire 
system,  and  restoration  of  the  power  of  deglutition,  the  patient 
being  in  a  semi-comatose  condition,  and  totally  unconscious. 
Children  having  convulsions  once,  are  usually  more  liable  to 
them  than  others,  and  they  will  frequently  come  on  from  slight 
causes. 

Diagnosis. — The  diagnosis  of  convulsions  is  very  easy,  there 
being  no  possible  chance  of  mistaking  the  symptoms.  The 
sudden  loss  of  consciousness,  convulsive  movement,  difficult  res- 
piration, and  frequent,  small  pulse,  can  not  be  confounded  with 
any  other  disease.  It  is  true  that  we  can  not  distinguish  between 
simple  convulsions  and  epilepsy,  except  by  the  lapse  of  time. 

Prognosis. — The  prognosis  is  usually  favorable,  though  it  is 
very  difficult  in  some  cases  to  arrest  the  convulsive  action.  Oc- 
casionally cases  will  be  seen  that  will  prove  fatal  in  spite  of 
treatment. 

PosT-MoRTEM  Examination. — The  scalpel  reveals  no  con- 
stant lesion  to  account  for  the  symptoms.  When  there  has 
been  determination  to  or  inflammation  of  the  brain,  we  of  course 
will  find  the  evidence  of  these  lesions.  But  when  the  disease 
has  arisen  from  an  extrinsic  irritation,  there  is  not  the  slightest 
evidence  of  disease  of  the  nerves. 

Treatment. — Our  primary  object  is  to  arrest  the  spasmodic 
movement  which  is  so  alarming  to  the  friends,  and,  no  matter 
how  often  seen,  to  some  extent  so  to  the  practitioner.  Calmness 
and  decision  are  very  important  requisites  in  this  case,  as  all 
around  the  patient  is  excitement,,  and  a  hundred  ex])edients  to 
benefit  the  sufferer  are  proposed. 


CO-N'VL'LSIONS.  413 

A  quick  examination  of  the  patient  will  enable  us  to  clasify 
our  cases  into  two  groups,  and  select  the  appropriate  remedy. 
In  the  one  there  is  marked  vascular  excitement,  with  irritation 
and  determination  of  blood  to  the  brain  and  spinal  cord ;  in  the 
other  the  circulation  is  feeble,  and  the  condition  is  one  of  atony. 
In  the  first  case  the  remedies  are  sedative,  in  the  second  they  are 
stimulant. 

If  the  convulsion  passes  off  so  that  remedies  can  be  given  by 
mouth,  we  will  add  to  a  half  glass  of  water  Tinct.  of  Aconite  or 
Veratrura  (as  indicated)  gtt.  v.,  Tinct.  of  Gelseminum  gtt.  x.  to 
gtt.  XXX.,  and  give  a  teaspoonful  every  ten  or  fifteen  minutes, 
until  the  convulsions  are  arrested,  then  less  frequently. 

If  there  is  a  markedly  pinched  expression  about  the  eyes  or 
base  of  the  brain,  Rhus  will  take  the  place  of  Gelseminum.  It 
is  especially  indicated  by  sudden  startings  and  a  shrill  cry  {cry 
encephalique).  If  the  patient  has  been  suffering  from  severe 
pain,  and  the  convulsions  have  come  on  during  a  paroxysm  of  it, 
we  would  give — ^.  Hydrate  of  Chloral  o'j.,  syrup,  water,  aa.  5j., 
a  half  teaspoonful  or  teaspoonful  sufficiently  often  to  arrest  the 
convulsions.  Sometimes  the  single  dose  will  be  sufficient,  some- 
times the  child  will  require  as  much  as  a  half  ounce  of  the 
mixture.  When  the  patient  is  full  blooded,  and  the  face  and  neck 
are  full  or  red.  Bromide  of  Potassium  may  be  added  to  the 
mixture. 

Asafoetida  is  a  remedy  when  there  has  been  irritation  of  the 
stomach  and  intestinal  canal,  with  gaseous  accumulatiou.  It  is  a 
stimulant,  and  ought  to  be  classed  with  the  second  group,  but 
the  gastro-intestinal  irritation  is  the  best  indication. 

Of  the  second  group  of  remedies  (stimulants),  Lobelia  will 
take  the  first  place.  It  is  indicated  by  an  oppressed  circulation 
and  respiration,  fullness  of  tissue,  and  want  of  expression,  when 
the  convulsion  has  passed  off.  Frequently  we  prescribe  from 
our  pocket-case —  I^  Tinct.  Lobelia  Seed  gtt.  x.  to  gtt.  xx., 
water  Siv.;  a  teaspoonful  every  fifteen  minutes  until  the  convul- 
sions have  ceased.  If  we  have  it  at  hand,  the  old-flishioned 
Comp.  Tincture  of  Lobelia  and  Capsicum  may  be  given  in  doses 
of  half  to  one  teaspoonful,  to  nausea  and  vomiting. 

Sulphuric  ether  is  a  good  remedy  in  these  cases,  and  may  be 
given  in  doses  often  drops  on  sugar  or  in  mucilage,  and  repeated 
frequently.     It  may  also  be  used  as  an  anaesthetic. 

Chloroform  may  occasionally  be  given   internally  in   doses  of 


414  DISEASES   OF  CHILDREN.  , 

ten  drops,  but  I  prefer  to  use  it  by  inhalation.  If  the  convul- 
sions are  severe,  with  but  little  interval  between  them  for  the 
administration  of  medicines,  or  if,  owing  to  their  severity,  we 
can  not  see  the  indications  for  remedies,  chloroform  should  be 
used  by  iuhalatiou  to  the  extent  of  complete  arrest  of  convulsive 
action,  and  continued  until  we  are  satisfied  that  we  have  the  case 
well  in  hand.  The  indicated  remedies  should  be  given  as  soon 
as  the  patient  can  swallow  them. 

One  of  the  best,  if  not  the  very  best  remedy  to  prevent  a  re- 
currence, of  convulsions  when  they  have  been  arrested,  is  the 
bromide  of  ammonium.  For  children  I  usually  prescribe  it  5'j. 
to  water  .5iv.,  and  give  teaspoonful  doses  as  often  as  may  be  re- 
quired (usually  every  three  or  four  hours).  It  may  be  given  for 
the  arrest  of  convulsions  in  some  cases  with  most  excellent  results. 
When  children  are  inclined  to  convulsions  the  preparation  of 
bromide  of  ammonium  should  be  kept  in  the  house,  and  its  ad- 
ministration directed  when  the  child  shows  the  slightest  symp- 
toms of  convulsive  action. 

As  convulsions  of  childhood  will  sometimes  run  into  confirmed 
epilepsy,  we  can  not  be  too  much  on  our  guard.  I  prescribe  the 
remedy  under  consideration,  and  insist  that  there  shall  never  be 
any  neglect  to  administer  it  if  indicated. 

If  a  hot  foot  bath  can  be  rightly  used,  it  will  be  of  advantage 
in  many  cases ;  there  must  be  a  bucket  of  water,  so  that  the  legs 
may  be  immersed  to  the  knees;  it  must  be  as  hot  as  the  child  can 
bear  it,  and  hot  water  must  be  added  every  ten  minutes  to  keep 
up  the  temperature,  and  both  child  and  bucket  must  be  sur- 
rounded by  a  blanket  or  shawl.  Thirty  minutes  is  the  least  time 
for  using  the  hot  foot  bath. 

The  sitz  bath  may  sometimes  be  employed  with  the  same  pre- 
cautions, and  even  a  general  bath.  When,  however,  there  is 
need  of  stimulating  the  skin,  the  hot  blanket  pack  may  be  used, 
or  the  child  may  be  rapidly  sponged  with  hot  water. 

When  the  temperature  is  very  high,  and  the  head  hot,  an 
enema  of  five  or  six  ounces  of  cold  water,  with  a  teaspoonful  of 
tincture  of  lobelia  may  be  given.  If  there  is  marked  prostration, 
hot  water  may  be  used  for  this  injection  and  Compound  Tinct. 
of  Lobelia  and  Capsicum  added. 

If  we  are  satisfied  that  the  convulsions  are  due  to  irritant  or 
crude  ingesta,  an  emetic  may  be  given  at  once.  Ten  grains  of 
Ipecac,    any  preparation    of  Lobelia,  or  even  salt  water,   will 


CHOREA.  415 

answer  our  purpose.  If  we  have  reason  to  believe  that  there  is 
irritant  material  in  the  intestinal  canal,  use  an  enema  of  warm 
water  to  which  we  have  added  compound  powder  of  jalap  and 
senna  5ss. 

In  the  treatment  of  disease  we  want  to  notice  the  symptoms 
of  convulsions  when  they  first  appear,  that  remedies  may  be 
selected  to  remove  them.  "An  ounce  of  prevention  is  worth  a 
pound  of  cure,"  at  least  it  saves  us  much  trouble.  Gelsemi- 
num,  Belladonna,  Rhus,  Lobelia,  Apis,  Veratrum,  Bromide  of 
Ammonium,  as  indicated,  will  usually  relieve  the  nervous  irrita- 
tion. The  rule  may  be  repeated — "the  indicated  remedy  is  the 
remedy  to  prevent  convulsions." 

CHOKEA 

This  affection,  known  commonly  as  8t.  Vitus'  Dance,  occurs 
most  generally  about  the  age  of  puberty,  though  it  sometimes 
appears  as  early  as  the  sixth  or  eighth  year,  and  as  late  as  tiie, 
thirteenth,  and  in  some  cases  later  than  this.  It  is  confined 
principally  to  the  female  sex,  but  in  rare  cases  it  is  met  with  in 
the  male.  Most  generally  it  is  associated  with  some  derange- 
ment of  the  sexual  organs,  and  it  is  not  unfrequently  associated 
with  hysteria.  We  usually  find  it  in  persons  of  feeble  health, 
and  precocious  mental  development,  but  in  some  cases,  in  persons 
of  the  opposite  character,  in  which  it  may  be  induced  by  torpor 
of  the  liver  and  bowels,  deranged  secretion  of  the  skin  and  kid- 
neys, and  from  close  confinement  or  sedentary  occupations. 

The  modern  disease  received  its  name,  doubtless,  from  the 
dancing  manias  of  the  middle  ages.  The  "dancing  plague"  or 
St.  Vitus'  dance,  commenced  in  Strasburg,  in  1418,  and  is  thus 
described  by  Burton  :  "Chorus  Sanctoe  Viti,  the  lascivious 
dance,  as  Paracelsus  calls  it,  because  they  that  are  taken  with  it 
can  do  nothing  but  dance  till  they  are  dead  or  cured.  It  is  so 
called  for  that  the  parties  were  wont  to  go  to  St.  Vitus  for  help, 
and  after  they  had  danced  there  a  while  they  were  certainly 
freed.  'Tis  strange  to  hear  how  long  they  will  dance,  and  in 
what  manner,  over  stools,  forms,  tables;  even  great-bellied 
women  sometimes  (and  yet  never  hurt  their  ciiildren)  will  dance 
so  long  that  they  can  stir  neither  hand  nor  foot,  but  seem  to  be 
quite   dead.     One    in   red    clothes    they  can    not    abide;    music 


416  DISEASES   OF   CHILDREX. 

above  all  things  they  love ;  and  therefore  magistrates  in  Ger- 
many will  hire  musicians  to  play  to  them,  and  some  lusty,  sturdy 
companions  to  dance  with  them." 

Another  form  of  the  dancing  mania,  termed  St.  John's  dance, 
commenced  in  1374,  and  extended  over  the  greater  portion  of 
Europe.  "At  Cologne  the  number  possessed  amounted  to  more 
than  five  hundred,  and  at  Metz  the  streets  are  said  to  have  been 
filled  with  eleven  hundred  dancers.  Peasants  left  their  plows, 
mechanics  their  workshops,  housewives  their  domestic  duties,  to 
join  the  wild  revels,  and  this  rich  commercial  city  became  the 
scene  of  the  most  ominous  disorder  ;  secret  desires  were  excited 
and  two  often  found  opportunities  for  wild  enjoyment ;  numer- 
ous beggars,  stimulated  by  vice  and  misery,  availed  themselves 
of  this  new  complaint  to  gain  a  temporary  livelihood.  Girls  and 
and  boys  quitted  their  parents,  and  servants  their  masters,  to 
amuse  themselves  at  the  dances  of  those  possessed,  and  greedily 
imbibed  the  poison  of  mental  infection.  Above  a  hundred  un- 
married women  were  seen  roving  about  in  consecrated  and  un- 
consecrated  places,  and  the  consequences  were  soon  perceived  ; 
gangs  of  idle  vagabonds,  who  understood  how  to  imitate  to  the 
life  the  gestures  and  convulsions  of  those  really  affected,  roved 
from  place  to  place  seeking  maintenance  and  adventures,  and 
thus,  wherever  they  went  spreading  this  disgusting  spasmodic 
disease  like  a  plague;  for  in  maladies  of  this  kind,  the  suscepti- 
ble are  infected  as  easily  by  the  appearance  as  the  reality." 
(Hecker.) 

This  gives  the  origin  of  the  name  of  the  affection  we  are  now 
considering,  and  though  there  is  no  similarity  between  the 
ancient  and  modern  St.  Vitus'  dance,  the  description  just  given 
illustrates  the  ease  with  which  nervous  affections  of  this  kind 
may  be  propagated.  And  it  is  a  fact,  proven  by  numerous  in- 
stances in  hospital  practice,  that  attacks  of  hysteria,  epilepsy, 
and  chorea,  will  be  excited  by  witnessing  the  malady  in 
another. 

As  regards  the  pathology  of  the  affection,  we  must  conclude 
that  there  is  an  irritation  of  the  true  spinal  cord,  arising  some- 
times from  debility,  and  at  others  from  extrinsic  causes  of  irri- 
tation. In  either  case  the  excitation  of  the  nervous  system  is 
indicative  of  debility,  rather  than  strength,  and  in  many  cases  is 
based  upon  feeble  nutrition  of  the  nerve  substance. 


CHOREA.  417 

Symptoms. — The  first  evidences  of  chorea  are  occasional  invol- 
untary movements  of  the  hands  and  the  facial  muscles,  and  an 
inability  to  sit  quietly  in  one  position.  Very  frequently  the 
fingers  are  quickly  and  involuntarily  moved,  and  when  the  pa- 
tient uses  the  hands  it  is  with  a  quick  unnatural  movement. 
As  the  disease  progresses  the  involuntary  movements  become 
continuous,  some  part  of  the  body  being  constantly  in  motion, 
and  the  movements  are  now  very  much  exaggerated.  If  the 
patient  attempts  to  do  anything,  she  seems  to  have  but  partial 
control  over  her  muscles,  and  while  they  are  being  directed  to 
the  end  intended,  they  are  going  through  a  succession  of  move- 
ments entirely  independent.  So  great  is  this,  sometimes,  that 
the  patient  can  not  sit  still,  nor  even  keep  the  hands  quiet  for  a 
moment,  and  her  walking  is  irregular  from  the  same  cause. 
The  facial  muscles  are  sometimes  very  much  involved,  and  the 
attempt  to  speak,  or  give  expression  to  the  emotions,  is  followed 
by  various  contortions  of  the  couutenance,  which  would  be 
laughable  were  they  not  connected  with  so  serious  a  malady. 
Sometimes  it  is  almost  impossible  for  the  patient  to  express  her- 
self intelligibly,  owing  to  spasmodic  action  of  the  muscles  of  the 
mouth  and  of  the  larynx. 

As  before  remarked,  the  general  health  is  usually  impaired 
previous  to  the  commencement  of  the  disease,  and  this  becomes 
more  marked  as  it  progresses;  symptoms  of  anaemia  are  of  com- 
mon occurrence,  the  skin  being  blanched,  the  pulse  feeble,  the 
lips  and  gums  pale,  variable  appetite,  imperfect  digestion  and 
constipation  of  the  bowels.  The  mind  is  more  or  less  affected, 
the  patient  being  low-spirited,  and  desiring  solitude,  the  counte- 
nance being  pale,  languid  and  vacant.  In  some  instances  con- 
firmed chlorosis  will  be  developed  during  the  progress  of  the 
disease.  It  will  be  noticed,  that  the  child  has  no  disposition  to 
play  or  to  take  exercise,  and  does  not  desire  to  associate  with 
others,  but  prefers  rather  to  get  where  her  infirmity  will  not  be 
noticed ;  the  sensitiveness  in  this  respect  being  sometimes  very 
great. 

Diagnosis. — Chorea  is  marked  by  such  distinctive  symptoms 
that  it  is  easily  recognized,  the  continual  partly  voluntary  and 
]>artly  involuntary  movements  not'  being  observed  in  any  other 
disease. 

Prognosis. — Though  in  some  cases  very  obstinate,  the  disease 
is  almost  always  curable.  It  may  last  for  two  or  three  weeks, 
27 


41J8  DISEASES  OF  CHILDREN. 

or  as  many  months,  and  in  some  rare  cases  for  years.     Usually 
it  disappears  as  the  general  health  is  improved. 

Post- Mortem  Examination. — In  fatal  cases  the  evidences 
of  anaemia  are  usually  very  marked,  the  tissues  being  very  pale, 
soft  and  flaccid.  The  different  organs  have  been  found  more  or 
less  diseased,  but  these  were  complications  and  bore  no  relation 
to  the  spasmodic  action.  We  would  expect  to  find  lesions  of  the 
brain  and  spinal  cord;  but  except  in  those  cases  terminating  in 
general  convulsions,  or  in  inflammation,  no  change  of  structure 
has  been  noticed. 

Treatment. — Various  plans  of  treatment  have  been  adopted, 
and  many  remedies  used  as  specifics  in  this  affection,  and  as  is 
usual,  we  find  that  where  the  means  are  so  abundant  they  are 
not  very  efficient.  We  had  much  better  adopt  a  rational  plan 
of  treatment,  by  correcting  any  dyscrasia,  and  getting  a  normal 
performance  of  the  various  functions  of  the  body,  rather  than 
depend  upon  any  one  remedy,  no  matter  how  highly  it  is  praised. 

The  disease  is  intimately  related  to  rheumatism  in  many  cases 
and  the  remedies  will  be  selected  from  the  class  of  anti-rheu- 
matics, to  which  the  reader  is  referred.  Macrotys  probably  stands 
first  on  the  list,  as  it  has  probably  benefited  more  patients  than 
any  other  remedy.  In  some  cases  it  is  given  alone,  in  others  it 
may  be  combined  with  Aconite  or  Veratrum,  in  others  with  Va- 
lerian, and  in  still  others  with  Arsenic.  One  of  the  best  prepa- 
rations T  have  ever  used  is — ^i  Tinct.  Macrotys  Sss.,  Tinct. 
Valerian  5iss.,  in  doses  of  five  to  twenty  drops  every  three  hours. 
With  Arsenic  the  prescription  will  be — '^i  Tinct.  Macrotys  3jv 
Fowlers  Solution  of  Arsenic  3ss.,  water  .^iv.;  a  teaspoonful  every 
four  hours. 

Sticta,  Bryonia,  Apocynum,  and  Colchicum,  have  all  been  used 
with  good  results,  as  has  the  iodide  of  potassium  when  the  tongue 
is  broad  and  of  a  bluish  pallor. 

If  the  disease  is  associated  with  amenorrhoea,  or  irregularity 
of  the  menstrual  function,  this  must  be  attended  to.  In  some 
cases  the  cmmenagogue  pill  of  the  Dispensatory  will  prove  use- 
ful, both  as  a  cathartic  and  for  its  action  on  the  uterus.  The 
wild  ginger  is  another  agent  that  will  prove  useful  in  some  of 
these  cases.  The  Macrotys,  or  Ciniicifuga,  has  already  been 
named  as  a  remedy  in  cases  where  the  patient  complains  of  wan- 
dering pains  in  various  parts  of  the  body,  or  pain  in  the  back 


CHOREA.  419 

and  limbs.  We  sometimes  associate  it  with  Valerian  or  Scutel- 
laria, and  sometimes  with  the  bitter  tonics.  The  extract  of 
Indian  hemp  has  been  employed  with  benefit,  in  doses  of  half  a 
grain  three  times  a  day,  and  good  results  are  said  to  have  attended 
the  administration  of  small  doses  of  Stramonium.  The  sulphate 
and  oxide  of  zinc  have  been  prescribed  oftener  possibly  than  any 
other  agents,  and  we  must  believe,  from  the  favorable  reports 
given,  that  they  have  an  action  in  these  cases  ;  these  remedies 
may  be  given,  commencing  with  half-grain  doses  four  times  a 
day,  and  gradually  increased  until  five  or  ten  grains  are  admin- 
istered. 

If  there  is  tenderness  on  pressure  over  the  spinal  cord,  coun- 
ter-irritation will  often  prove  very  efficient,  and  the  same  will 
be  the  case  when  there  is  tenderness  over  the  epigastrium. 

Electricity  has  been  frequently  resorted  to  in  chorea,  and  the 
reports  of  its  action  differ  materially.  When  passed  through 
the  limbs  it  is  not  only  useless,  but  sometimes  positively  injuri- 
ous; but  when  applied  to  the  spine  it  is  almost  always  beneficial. 
The  common  electro-magnetic  battery  may  be  employed,  the 
negative  pole  being  applied  to  the  sacrum,  and  the  positive 
passed  backward  and  forward  over  the  spine.  The  better  plan, 
however,  is  to  insulate  the  patient,  and  by  the  old-fashioned 
electric  machine,  charge  the  patient  and  withdraw  the  spark 
from  the  back.  In  one  case  I  have  employed  the  bromide  of 
ammonium  in  addition  to  a  tonic  treatment,  and  seemingly  with 
marked  benefit. 

Very  much  will  depend  upon  the  home  management  of  the 
patient.  All  causes  of  irritation  must  be  carefully  avoided,  and 
she  should  be  encouraged  to  take  suitable  exercise,  and  try  to 
control  the  involuntary  movements.  Out-door  exercise,  pleasant 
company,  and  something  to  constantly  occupy  the  mind  with, 
exert  an  important  influence,  and  it  will  sometimes  be  found 
that  where  the  patient  is  allowed  to  have  her  own  way,  if  not 
decidedly  improper,  she  will  get  along  better.  In  some  cases 
the  disease  results,  in  both  male  and  female,  from  sexual  excita- 
tion and  onanism ;  this  should  be  looked  into,  and  if  reasonable 
evidence  exists,  means  should  be  employed  to  put  a  stop"to  it. 
The  manner  of  doing  this  will  have  to  be  left  to  the  discretion 
of  the  physician,  and  will  vary  in  different  cases. 


420  DISEASES  OF   CHILDREN. 

TRISMUS    NASCENTIUM. 

Infantile  tetanus  is  of  very  rare  occurrence,  and  a  physician 
may  be  in  practice  a  lifetime  without  seeing  a  case.  It  occurs 
most  frequently  in  the  children  of  the  poor,  especially  in  badly 
ventilated  dwellings,  and  when  the  mother  and  child  have  had 
insufficient  food,  clothing,  etc.,  and  a  want  of  cleanliness.  That 
it  does  not  always  depend  upon  these  conditions,  I  have  evidence 
in  one  case  that  came  to  my  knowledge,  in  a  family  in  comfort- 
able circumstances. 

Causes. — The  conditions  above  named  may  be  considered 
as  predisposing  causes.  The  exciting  cause  is  an  unhealthy  in- 
flammation of  the  navel ;  the  disease  is,  therefore,  really  trau- 
matic tetanus. 

Pathology. — The  tetanic  convulsion  is  dependent  upon  irri- 
tation of  the  spinal  coM  and  excess  of  reflex  action.  Post-mortem 
examination  shows  an  inflammatory  condition  of  the  unbilical 
vessels,  and  of  the  peritoneum  about  the  umbilicus  and  reflected 
upon  the  artery  and  veins.  Examination  of  the  spine  shows  in- 
jection of  the  arachnoid  and  pia  mater,  with  effusion  of  serum, 
lymph,  and  sometimes  of  blood. 

Symptoms. — The  disease  may  make  its  appearance  in  a  day  or 
two  after  birth,  but  more  frequently  about  the  ninth  day.  The 
child  is  observed  to  be  restless  and  fretful,  sleeps  badly,  and  has 
paroxysms  of  crying  which  seem  like  colic.  It  moves  the  lower 
extremities  in  a  peculiar  manner,  does  not  nurse  well,  and  has 
greenish  and  slimy  discharges  from  the  bowels. 

These  symptoms  continuing  for  a  time,  it  is  attacked  with 
convulsions,  which  are,  however,  very  irregular.  "These  con- 
vulsive motions  recur  at  uncertain  intervals,  and  produce  vari- 
ous effects.  Sometimes  the  agitation  is  very  great ;  the  mouth 
foams;  the  thumbs  are  rivited  into  the  palms  of  the  hands;  the 
jaws  are  locked  from  the  commencement,  so  as  to  prevent  the 
action  of  sucking  and  swallowing  ;  any  attempt  to  wet  the  month 
or  fauces,  or  to  administer  the  medicines,  seems  to  aggravate  the 
spasms;  and  the  face  becomes  turgid  and  of  a  livid  hue,  as  do 
most  other  parts  of  the  body.  From  this  latter  circumstance 
nurses  speak  of  this  form  as  the  'black  fits.'  The  conflict  lasts 
from  eight  to  thirty  hours,  and  in  some  rare  instances  to  about 


NIGHT   TERRORS.  421 

forty  hours ;  when  the  powers  of  nature  seem  to  sink  exhausted 
and  overpowered  by  their  own  exertions." 

Treatment. — Put  the  child  upon  the  use  of  Veratrura  and 
Gelseminum  in  full  doses,  as — ^.  Tincture  of  Veratrum  gtt.  v., 
Tincture  of  Gelseminum  5ss.,  water  5ij. ;  a  teaspoonful  every 
hour.  As  it  is  not  very  easy  to  give  the  entire  teaspoonful  at 
once,  it  may  be  given  in  smaller  doses  through  the  hour,  or  the 
quantity  of  water  may  be  lessened.  When  the  disease  is  very 
persistent  I  should  not  hesitate  to  double  or  even  quadruple  the 
quantities  of  the  remedies  named. 

Locally  the  application  of  a  warm  emollient  poultice  to  the 
abdomen  over  the  umbilicus  will  be  found  beneficial.  Ulraus 
fulva,  flaxseed,  or  anything  of  a  similar  character  may  be  used  ; 
or  in  place  of  these,  application  of  a  cloth  spread  with  the  mild 
zinc  ointment  will  answer  a  good  purpose. 

NIGHT    TERRORS. 

We  are  consulted  occasionally  with  regard  to  the  sudden 
waking  of  the  child  at  night,  manifesting  every  evidence  of  ter- 
ror. Generally  it  wakes  with  a  piercing  scream,  and  starts  up 
in  bed  with  affright,  and  it  is  some  minutes  before  it  can  be 
assured  that  it  is  safe,  and  quieted.  There  may  be  but  one 
paroxysm  through  the  night,  but  occasionally  there  will  be  two 
or  three.  In  some  cases  it  will  also  occur  when  the  child  sleeps 
in  the  daytime. 

Many  persons  think  that  this  grows  out  of  frights  from  play- 
mates or  servants,  or  fearful  stories  about  ghosts,  giants,  robbers, 
etc.,  which  are  so  frequently  told  to  children.  While  this  gives 
rise  to  a  morbid  fear,  manifesting  itself  especially  after  dark,  but 
also  following  the  person  in  the  day,  it  has  little  or  nothing  to 
do  with  this  case. 

In  this  there  is  an  irritation  of  the  brain  with  determination 
of  blood,  and  the  night  terrors  are  similar  in  their  cause  to  con- 
vulsions and  epilepsy,  the  first  being  of  the  cerebrum — the  intel- 
lectual portion,  the  second  of  the  spinal  cord — or  of  automatic 
movement. 

The  use  of  small  doses  of  Aconite  with  Rhus,  given  in  the  after- 
noon and  evening,  will  frequently  remove  the  unpleasantness. 
In  some  cases  the  indications  are  very  clear  for  Gelseminum  and 


422  DISEASES  OF    CHILDREN. 

we  use  it  in  place  of  Rhus.  In  other  cases  there  is  an  irritation 
of  the  skin  associated  with  the  unpleasant  dreams,  and  Apis  or 
Belladonna  will  come  in  play.  If  the  child  is  nervous  and  sobs 
in  its  sleep,  Pulsatilla  will  be  the  remedy,  and  it  may  be  given 
three  or  four  times  daily. 

In  some  cases  we  will  find  a  torpid  condition  of  the  bowels, 
which  will  require  the  administration  of  a  mild  cathartic.  In 
some,  very  small  doses  of  podophyllin,  thoroughly  triturated  and 
combined  with  hydrastia,  will  be  found  to  answer  the  purpose 
well. 

A  tonic  and  restorative  treatment  will  almost  always  be  neces- 
sary. Here  I  would  put  the  child  upon  the  use  of  our  common 
prescription  :  ^.  Tincture  of  Muriate  of  Iron  5ss.,  Glycerine 
5ij. ;  a  teaspoonful  three  times  a  day  ;  or  the  compound  syrup  of 
the  hypophosphites. 

PARALYSIS. 

Infantile  paralysis  is  a  very  different  disease  from  that  we  are 
called  to  treat  in  the  adult.  We  are  accustomed  to  think  of 
paralysis  as  a  loss  of  motion  or  sensation ;  in  this  case  there  is 
but  diminution  of  one  or  both.  In  slight  degree  it  is  met  with 
quite  frequently,  and  I  have  no  doubt  that  it  is  often  overlooked, 
or  attributed  to  something  else. 

Causes. — It  is  very  difficult  to  determine  the  causes  of  infan- 
tile paralysis.  In  most  cases  I  believe  there  is  a  congenital  fee- 
bleness of  the  nerve  centers,  and  afterward  from  imperfect  nutri- 
tion the  disease  is  developed.  In  other  cases  it  is  the  result  of 
injury  to  the  spine,  usually  from  bad  nursing  or  from  a  fall. 

Pathology. — The  pathology  of  the  disease  is  pretty  clearly 
stated  above — enfeeblement  of  the  nerve  centers  and  impaired 
nutrition.  I  do  not  think  that  I  have  seen  evidence  of  any  other 
lesion  in  the  cases  I  have  examined. 

Symptoms. — In  the  majority  of  cases  we  will  first  notice  the 
difficulty  in  feebleness  of  tlie  lower  extremities,  and  an  imperfect 
command  over  them.  Usually  one  side  is  principally  affected, 
and  the  disease  seems  to  be  of  one  or  more  articulations.  I 
have  noticed  it  oftenest  in  the  hip,  and  from  the  eversion  of  the 
toes,  and  shortening  of  the  limb,  have  felt  confident  there  was  a 


PARALYSIS.  423 

dislocation.  Careful  examination,  however,  could  detect  no 
lesion.  In  other  cases  the  whole  pelvis  seemed  to  be  affected, 
having  no  strength  to  support  the  body,  giving  a  very  feeble 
point  of  action  for  the  muscles  of  the  extremities. 

More  rarely  we  see  cases  of  paralysis  of  the  upper  extremities, 
yet  they  are  easily  recognized  by  the  sameness  of  the  symptoms. 
The  mother  thinks  the  child's  arm  has  been  dislocated,  or  has 
been  injured  in  some  way,  and  attributes  the  loss  of  power  to 
this.  On  first  looking  at  the  arm,  we  suspect  a  dislocation,  its 
position  is  so  unnatural  and  its  movements  so  feeble,  but  an  ex- 
amination shows  the  bones  in  their  proper  place. 

Facial  paralysis  is  still  more  rare,  but  cases  are  on  record. 
Paralysis  of  the  third  pair  of  nerves,  causing  falling  of  the  upper 
eyelid,  or  ptosis,  is  occasionally  seen.  Again,  a  single  muscle 
may  be  affected,  as  when  from  paralysis  of  a  sterno-mastoid  we 
have  torticollis. 

Treatment. — Of  course  the  treatment  will  be,  to  some  extent, 
dependent  upon  the  cause,  and  a  careful  examination  will  be  in- 
stituted to  determine  the  lesion  which  has  given  rise  to  it.  If 
from  irritation  of  the  stomach  and  intestinal  canal,  this  should 
be  removed,  and  means  employed  to  restore  digestion.  If  worms 
are  thought  to  be  present,  the  Podophyllin  and  Santonine  may 
be  given.  If  from  irritation  of  the  urinary  apparatus,  this  must 
be  relieved. 

Outside  of  these  wrongs,  which  may  be  the  cause  of  paralysis, 
we  look  to  the  nerve  centers  for  the  wrong,  and  here  we  will  be 
guided  by  the  special  indications  for  remedies.  Nux  vomica  will 
frequently  be  indicated,  there  being  evidences  of  an  enfeebled 
circulation.  With  flushed  face  and  contracted  pupils  the  patient 
will  have  Gelseminum,  usually  with  one  of  the  sedatives.  If  the 
patient  is  dull  and  inclined  to  sleep,  Belladonna  will  be  given ; 
and  with  sluggish  muscular  action,  Ergot.  Rhus  is  indicated  by 
the  sharp  pulse,  frontal  headache,  and  red  papillae  of  tongue ; 
Bryonia  by  the  corded  pulse,  and  flushed  right  cheek;  Macrotys 
by  muscular  pain  and  soreness. 

Inunction  with  quinine  has  been  of  marked  benefit  in  these 
cases ;  even  friction  with  a  fatty  matter  (lard)  is  of  advantage. 
Brisk  friction  to  the  spine  and  the  part  affected,  with  salt  and 
water,  using  the  open  hand,  is  good.  In  some  cases  the  use  of 
water  is  injurious,  and  I  direct  dry  friction  with  flannel  or  silk ; 


424  DISEASES   OF  CHILDREN. 

this  is  especially  useful  in  cases  in  which  there  seems  a  deficiency 
of  electricity. 

Benefit  is  derived  from  the  moderate  use  of  electricity,  passino- 
the  current  downward  from  the  spine  through  the  muscles.  The 
Voltaic  electricity,  used  by  the  method  called  "  Faradization,"  I 
believe  to  possess  the  most  active  curative  properties. 

The  child  should  be  taken  into  the  open  air,  and  have  an  abun- 
dant supply  of  light,  and  even  sunlight,  where  it  passes  most  of 
its  time.  It  should  also  be  instructed  to  call  the  paralyzed  parts 
into  action  as  much  as  possible,  and  control  their  movements. 
Practice  in  this  direction  is  often  attended  with  the  happiest 
results. 


CHAPTER     X. 
DISEASES    OF    THE    EYES. 


The  eye  is  one  of  the  most  important  organs  of  the  body,  and 
though  its  diseases  do  not  endanger  life,  their  favorable  termina- 
tion is  as  anxiously  watched  for  by  both  patient  and  friends  as 
that  of  the  more  grave  maladies.  As  regards  the  pathology  of 
these  affections,  we  will  find  it  the  same  as  in  other  portions  of 
the  body,  and,  as  a  general  rule,  the  same  treatment  will  be  ap- 
plicable. Inflammation  of  the  structures  of  the  eye  is  the  same 
disease  as  inflammation  of  any  other  part  of  the  body,  differing 
only  as  regards  the  peculiarity  of  structure  and  function  of  the 
parts.  And  in  the  treatment  of  this  affection  the  same  general 
principles  apply  in  the  one  case  as  in  the  other.  So  it  is  in  all 
other  diseases,  and  he  who  properly  understands  the  pathology 
and  nature  of  the  affection  need  be  at  no  loss  for  appropriate 
treatment. 

The  organ  of  sight,  it  will  be  recollected,  consists  of  two  parts, 
the  eye  itself  and  its  appendages,  the  latter  being  two  palpebra 
or  lids,  the  conjunctiva  or  investing  membrane,  the  lachrymal 
apparatus,  the  muscles  moving  the  eye,  and  the  cellular  and  adi- 
pose tissues  which  form  its  bed.  Each  of  tlipse  parts  may  be 
diseased,  but  some  of  them  so  rarely  that  it  is  hardly  worth  while 


OPHTHALMIA   NEONATORUM.  425 

to  notice  them  in  this  place.  The  globe  of  the  eye  is  composed 
of  three  tunics — the  external,  composed  of  the  sclerotic  and  cor- 
nea ;  the  middle,  of  the  choroid ;  and  the  internal,  the  retina  or 
expansion  of  the  optic  nerve.  It  has  a  muscular  septum  divid- 
ing it  into  two  parts — the  iris;  and  it  has  three  humors  possess- 
ing different  degrees  of  density — the  aqueous,  the  vitreous,  and 
the  crystalline  lens. 

OPHTHALMIA    NEONATORUM. 

The  sore  eyes  of  the  newly  born  child  vary  very  greatly  in 
character,  from  simple  conjunctivitis  to  that  grave  inflammation 
which,  involving  structure  after  structure,  destroys  the  organ  in 
a  few  days. 

Causes. — In  some  cases  it  is  the  result  of  awkward  washing, 
either  from  the  irritation  of  soap  in  the  eye  or  rubbing ;  these 
are  always  mild  and  of  short  duration.  In  others  the  conjunc- 
tivitis arises  from  exposure  to  a  bright  light,  which  induces  irri- 
tation ;  and  in  some  it  is  caused  by  cold. 

The  severer  cases  are  thought  to  arise  from  the  introduction 
of  purulent  matter  into  the  eyes  from  the  soft  parts  of  the  mother 
while  the  child's  head  was  passing  through  the  vagina.  The 
severest  inflammation  of  the  eyes  known,  is  caused  by  inocula- 
tion with  gonorrhoeal  virus,  and  we  have  abundant  evidence  that 
other  purulent  discharges  from  the  vagina  are  quite  as  virulent. 

Pathology. — In  the  milder  cases  the  inflammation  is  confined 
to  the  conjunctiva,  and  is  but  little  more  than  determination  of 
blood.  In  the  severer  cases  the  inflammation  is  at  first  of  the 
conjurctiva,  but  of  very  active  character,  impairing  the  vitality 
of  the  tissues,  and  giving  rise  to  free  suppuration.  In  many 
cases  it  gives  rise  to  separation  of  tissues,  producing  phlydenula, 
and  extending  to  the  cornea,  causes  ulceration.  In  still  severer 
cases  it  extends  to  the  deep-seated  structures  of  the  eye,  causing 
softening,  suppuration,  and  other  lesions  that  destroy  the  organ. 

Symptoms. — In  the  milder  cases  the  eyes  are  observed  to  be 
injected,  and  the  child  dislikes  to  expose  them  to  a  strong  light. 
In  a  few  days  a  tenacious  secretion  accumulates  at  the  margin  of 
the  lids,  and  agglutinates  them  together.  The  eyes  may  remain 
sore  in  this  way  for  a  week  or  two,  occasionally  causing  the  child 
to  be  restless  and  fretful. 


426  DISEASES   OF   CHILDREN. 

In  the  severer  form  of  the  disease,  the  eyes  are  noticed  to  be 
red,  and  the  lids  much  swollen,  and  from  the  first  the  child  seems 
to  suflPer  much  paiu  in  them,  and  keeps  them  tightly  closed  the 
most  of  the  time.  By  the  second  day  all  these  symptoms  are 
increased,  the  swelling  being  very  marked,  and  when  the  eyelids 
are  separated,  the  entire  surface  is  seen  to  be  involved  in  the 
inflammation,  the  conjunctiva  being  injected  and  thickened.  By 
the  third  or  fourth  day,  there  is  a  free  discharge  of  yellowish 
purulent  matter  from  the  eye,  and  the  intolerance  of  light  is 
extreme.  When  the  lids  are  opened  the  conjunctiva  is  seen  to  be 
much  swollen,  and  many  times  the  chemosis  is  so  great  that  the 
cornea  can  hardly  be  seen. 

Continuing  in  this  way,  the  disease  may  run  its  course  to  the 
destruction  of  the  eye  in  three  or  four  days,  or,  as  in  the  major- 
ity of  cases,  it  will  last  as  many  weeks,  and  the  child  will  slowly 
recover. 

Treatment. — I  have  great  faith  in  the  value  of  internal  rem- 
edies in  disease  of  the  eyes,  though  the  proper  local  means  should 
not  be  neglected.  Prepare  for  the  child  Aconite  in  the  usual 
doses,  with  Gelseminum,  Rhus,  Belladonna,  Phytolacca,  or  Apis, 
as  may  be  indicated.  The  child  may  also  be  medicated  through 
the  mother,  if  her  health  is  impaired.  Not  unfrequently  the 
unpleasant  coating  upon  the  tongue,  the  bad  breath,  and  imper- 
fect digestion,  will  call  for  sulphite  of  soda  or  sulphurous  acid. 

The  eyes  should  be  kept  free  from  the  discharge  (clean)  by 
washing  them  every  two  or  three  hours  with  warm  water,  to 
which  may  sometimes  be  added  a  small  portion  of  salt.  In  some 
cases  the  water  may  be  used  as  hot  as  it  can  be  borne.  To  thor- 
oughly cleanse  the  eye,  the  lids  may  be  opened  and  the  water 
allowed  to  trickle  through,  to  wash  the  pus  aSvay. 

A  lotion  of  Aconite  or  Veratrum  (5j.  to  5j.)  applied  above 
and  around  the  eyes,  and  sometimes  to  the  lids,  will  give  relief. 

In  cases  of  moderate  severity  a  collyrium  may  be  made  by 
adding  Tinct.  Belladonna  or  Gelseminum  to  water.  Or  in  a 
more  advanced  stage  a  solution  of  atropia  may  be  employed 
(gr.  I  to  water  .^j.),  or  an  infusion  of  Baptisia  filtered,  or  a  solu- 
tion of  Hydrastia  (Berberin),  grs.  ij.  to  water  .5j- 

If  the  case  is  very  serious,  and  the  eye  is  endangered,  nitric 
acid  may  be  applied  to  the  surface  of  the  lids  (everted),  using  a 
pine  pencil.  I  think  it  preferable  to  the  nitrate  of  silver  which 
is  so  commonly  used  in  these  cases. 


DISEASES   OP   THE   EYE.  427 


DISEASES  OF  THE  APPENDAGES  OF  THE  EYE. 

The  eyelids  may  be  the  subject  of  phlegmonous  inflammation, 
usually  associated  with  erysipelas.  They  are  swollen  and  livid, 
and  very  painful,  and  occasionally  the  inflammation  extends  to 
the  cellular  tissue  of  the  orbit.  It  may  terminate  in  resolution 
or  suppuration,  the  pain  being  severe  and  throbbing  when  pus 
has  formed,  and  the  constitutional  symptoms  tolerably  well 
marked.  If  the  inflammation  is  dependent  upon  erysipelas,  we 
may  apply  equal  parts  of  tincture  of  muriate  of  iron  and  glyce- 
rine, every  two  or  three  hours,  keeping  a  cloth  wet  with  the  same 
over  it ;  if  from  other  causes,  a  poultice  of  equal  parts  of  Hydras- 
tis and  Ulmus,  or  cloths  dipped  in  a  decoction  of  Cornus,  with  a 
small  portion  of  tincture  of  Aconite.  The  bowels  may  be  moved 
with  any  simple  laxative,  and  if  necessary,  a  diaphoretic  and 
diuretic  given.  If  suppuration  occurs,  the  abscess  should  be 
carefully  opened  as  soon  as  it  is  detected,  as  if  it  remains  it  in- 
creases in  size,  and  sometimes  causes  great  destruction. 

Furuncle,  or  boils  of  the  eyelid,  are  of  very  frequent  occurrence, 
and  sometimes  occasion  much  suffering.  Occasionally  they  pass 
through  their  stages  rapidly,  a  week  sufficing  for  their  removal, 
but  in  other  cases  they  are  very  chronic.  When  formed  on  the 
edge  of  the  eyelid,  they  are  called  styes,  and  are  smaller  but  not 
less  painful.  They  require  but  little  attention,  except  in  such 
cases  as  would  be  injured  by  the  continued  pain  and  restlessness 
produced  by  them.  In  such  cases  they  may  be  incised,  and  if 
pus  has  not  yet  formed,  touched  freely  with  a  crystal  of  sulphate 
of  zinc,  and  a  poultice  applied. 

In  such  cases  lime  water  may  be  given  with  benefit,  to  prevent 
the  recurrence  of  them.  The  general  health  is  also  improved. 
In  place  of  lime  water  we  may  employ  sulphide  of  lime  in  doses 
of  one  eighth  of  a  grain  four  times  a  day. 

Ptosis,  or  falling  of  the  upper  eyelid,  is  caused  by  paralysis  of 
the  third  pair  of  nerves,  or  by  disease  affecting  the  eyelid,  or  the 
levator  muscle.  In  cases  of  paralysis,  it  may  be  relieved  some- 
times by  the  use  of  electricity  or  local  stimulant  applications  and 
the  proper  internal  remedies;  failing  in  this  and  in  the  cases  not 
dependent  upon  paralysis,  a  surgical  operation  is  demanded. 
Entropium  or  inversion  of  the  eyelids,  and  ectropium  or  eversiou, 
are  only  remediable  by  surgical  operations. 


428  DISEASES  OF  CHILDREN. 

Trichiasis,  or  inversion  of  the  eyelashes,  is  popularly  known 
as  "wild  hairs  in  the  eye,"  and  is  often  a  source  of  great  irrita- 
tion or  inflammation.  The  trouble  is  owing  to  a  misdirection  of 
the  cilia,  a  portion  of  them  being  turned  inward,  so  as  to  come 
in  contact  with  the  eye.  The  cause  is  usually  easily  detected  by 
turning  the  patient's  eye  to  a  strong  light  and  slightly  raising 
the  lid,  the  faulty  hairs  being  seen  to  pass  inward  to  the  con- 
junctiva. They  are  usually  of  a  light  color,  smaller  and  much 
more  flexible  than  the  normal  ones,  and  for  these  reasons  are 
sometimes  detected  with  difficulty.  In  cases  of  partial  trichiasis 
the  treatment  is  easy,  and  consists  simply  in  removing  the  of- 
fending cilia  with  a  pair  of  forceps.  I  can  yet  feel  the  mortifi- 
cation I  once  experienced,  in  which,  after  treating  a  case  of 
''sore  eyes"  for  two  weeks,  the  patient  was  cured  in  forty-eight 
hours  by  an  old  woman  removing  these  faulty  hairs.  In  severe 
cases  this  will  not  answer,  a  surgical  operation  being  necessary. 


DISEASES  OF   THE   LACHRYMAL   APPARATUS. 

The  lachrymal  gland  is  so  protected  within  the  orbit  that  it  is 
rarely  the  seat  of  disease.  Inflammation  sometimes  occurs,  and 
is  marked  by  pain  in  the  region  of  the  gland  and  dryness  of  the 
eye  from  arrest  of  secretion.  When  the  inflammation  subsides 
there  is  usually  too  free  secretion  and  epiphora,  but  this  soon  sub- 
sides.    It  should  be  treated  as  any  other  inflammation. 

Inflammation  of  the  lachrymal  sac  is  of  frequent  occurrence, 
and  requires  care  in  its  management.  It  makes  its  appearance 
usually  as  a  diffused,  erysipelatous-like  redness  and  swelling  of 
the  parts  near  the  internal  canthus,  with  deep-seated  pain,  and 
more  or  less  irritation  of  the  conjunctiva,  increased  lachrymation, 
and  passage  of  the  tears  over  the  eyelid.  Tlie  inflammation  con- 
tinuing for  some  days,  the  parts  become  much  swollen  and  very 
painful,  and  at  last  pus  having  formed,  it  discharges  through 
the  integument.  In  some  cases  the  pus  finds  its  way  through 
the  lachrymal  canals  by  pressure,  and  the  inflammation  becomes 
chronic,  but  without  the  formation  of  a  fistula.  Usually  there 
is  closure  of  the  nasal  duct,  which  remains  permanent  unless  an 
operation  is  undertaken  for  its  removal,  though  sometimes  the 
closure  of  the  nasal  duct  is  the  primary  affection,  the  inflamma- 
tion of  the  lachrymal  sac  being  caused  by  it. 


DISEASES   OF   THE   EYE.  429 

The  child  should  have  the  right  internal  treatment  as  for  any 
other  disease,  in  the  use  of  Aconite  or  Veratrum,  with  Phyto- 
lacca, Rhus,  Gelseminum,  Belladonna,  or  whatever  remedy  may 
be  indicated.  If  now  the  part  is  penciled  with  Tincture  Aconite 
or  Tincture  Veratrum  in  the  first  stage,  or  has  a  wet  dressing 
of  !^  Salicylic  Acid,  Borax,  aa.,  gr.  x.,  water  5iv.,  if  suppuration 
is  threatened,  we  usually  get  along  well.  In  some  cases  the  deep 
redness  will  indicate  Tincture  Muriate  of  Iron5jv  Glycerine  Sss., 
applied  to  the  part.  If  pus  forms,  an  incision  should  be  early 
made  for  its  removal,  thus  preventing  change  of  the  lachrymal 
sac,  and  especially  distension,  and  permanent  closure  of  the  nasal 
duct.  An  injection  of  ten  or  twenty  grains  of  sesqui-carbonate 
of  potash  to  the  ounce  of  water,  will  now  assist  very  much  in 
effecting  a  speedy  cure.  As  soon  as  the  inflammation  subsides, 
if  the  nasal  duct  seems  closed,  a  style  should  be  inserted. 

Closure  of  the  nasal  duel,  producing  fistula  lachrymalis,  fre- 
quently results  from  the  above  inflammation,  though  it  may  be 
produced  by  injuries  of  the  bones  or  soft  parts,  or  an  extension 
of  inflammation  to  its  mucous  lining  from  the  nose,  or  from  the 
conjunctiva.  In  a  majority  of  cases  there  is  a  fistulous  opening 
over  the  lachrymal  sac,  or  a  continuous  suppuration  and  dis- 
charge of  pus  at  the  internal  canthus,  through  the  puncta,  with 
more  or  less  frequent  attacks  of  acute  inflammation  of  the  sac, 
and  discharge  through  the  integument.  In  some  of  these  cases 
a  fungous-looking  mass  of  considerable  size  is  found  upon  the 
site  of  the  lachrymal  sac,  which  is  constantly  discharging  pus 
mixed  with  tears.  This  and  the  constant  flowing  of  the'  tears 
over  the  eyelid,  is  very  unpleasant,  and  occasionally  it  keeps  up 
continuous  irritation  of  the  eye,  and  causes  imperfect  vision. 
The  disease  is  only  cured  by  an  operation,  which  consists  in 
opening  the  lachrymal  sac  and  introducing  a  silver  style  made  for 
the  purpose.  The  usual  means  to  relieve  irritation  are  then 
made  use  of,  and  the  style  retained  until  there  is  evidence  of  the 
free  passage  of  tears  and  restoration  of  the  mucous  membrane 
lining  the  duct,  when  it  is  removed,  and  the  external  opening 
allowed  to  heal. 

The  puncta  or  canalicnli  may  be  obstructed  from  inflammatory 
action,  and  occasionally  from  other  causes.  In  these  cases  there 
is  also  the  overflow  of  tears  and  irritation  of  the  lid.  If  it 
is  produced  by  inflammation,  the  means  heretofore  named  may 
be  used  to  arrest  it.     If  from  other  causes  an  Anel's  probe  may 


430  DISEASES  OF  CHILDREN. 

be  passed  into  the  puucta  and  through  the  canaliculi  into  the  sac, 
with  the  result  of  removing  the  obstruction. 

The  caruncula  lachrymalis  is  sometimes  the  seat  of  inflamma- 
tion very  similar  to  that  in  ophthalmia  tarsi,  and  by  displace- 
ment of  the  puncta  will  produce  watering  of  the  eye.  It  some- 
times gives  rise  to  considerable  uneasines  and  pain.  It  may  be 
treated  in  the  same  manner  as  the  other  inflammations  named, 
but  when  persistent  is  best  removed  by  the  use  of  the  mild  zinc 
ointment,  or  ophthalmic  ointment.  Occasionally  they  are  the 
subject  of  chronic  enlargement,  forming  a  red,  soft,  tuberculated 
tumor,  of  considerable  size,  which  bleeds  readily  on  pressure.  It 
may  be  occasionally  removed  by  the  application  of  a  saturated 
solution  of  tannic  acid,  or  the  solid  nitrate  of  silver,  but  in  many 
cases  will  have  to  be  excised,  one-half  or  more  being  cut  away, 
the  remainder  disappears. 

PTERYGIUM. 

This  is  strictly  a  disease  of  the  conjunctiva,  and  consists  of  a 
thickening  of  a  circumscribed  portion  of  it  extending  between 
the  internal  canthus  and  the  cornea,  though  occasionally  it  is 
found  on  the  temporal  side.  It  is  divided  into  two  kinds,  the 
membranous  and  fleshy,  both  kinds  being  triangular,  with  the 
apex  toward  the  cornea.  It  commences  from  without,  and  grows 
inward,  occasioning  but  little  disturbance  until  it  reaches  the 
cornea.  If  it  commences  to  involve  the  conjunctiva-cornea,  it 
gives  rise  to  irritation,  and  may  be  attended  with  serious  conse- 
quences. It  may  be  arrested  by  cauterizing  with  nitrate  of 
silver,  nitric  acid,  or  other  escharotics,  but  the  easiest  plan  is  to 
dissect  off  the  half  next  the  cornea,  when  the  remainder  will 
generally  disappear  without  trouble. 

OPHTHALMIA    TARSI. 

Inflammation  of  the  edges  of  the  eyelids  is  noticed  more  fre- 
quently in  children  than  in  the  adult,  and  is  frequently  associated 
with  some  depraved  habit  of  body,  as  scrofula.  When  primary, 
it  may  be  the  result  of  cold,  smoke,  impure  air,  or  filthiness;  but 
it  is  most  usually  a  sequence  of  catarrhal  ophthalmia  or  scrofu- 
lous conjunctivitis.  The  disease  is  located  in  the  edge  of  the  lid 
and  meibomian  follicles,  and  in  many  cases  so  affects  the  roots 
of  the  eye-lashes  as  to  cause  them  to  fall  out,  hence  that  appear- 


OPHTHALMIA   TAESI.  431 

ance  termed  "  blear-eyed."  The  eyes  look  sore  and  tumid,  and 
the  patient  complains  of  a  sensation  of  roughness,  and  as  if  there 
were  sand  in  the  eye,  when  the  lids  are  moved,  and  thus  there  is 
the  constant  tendency  to  keep  them  partially  closed.  They  are 
agglutinated  together  in  the  morning,  sometimes  so  much  so  that 
the  patient  has  to  soften  them  before  he  can  open  them,  and  it  is 
even  then  attended  with  pain.  Ophthalmia  tarsi  is  essentially  a 
chronic  affection,  with  but  little  tendency  to  spontaneous  recov- 
ery, and  is  sometimes  very  difficult  to  cure ;  and  if  the  meibomian 
glands  are  closed,  the  edge  of  the  lid  has  a  shining,  glistening 
appearance. 

Treatment. — As  there  is  almost  always  a  faulty  constitution, 
■with  marked  evidence  of  some  cachexia,  we  find  it  important  to 
put  the  patient  upon  an  alterative  and  tonic  course  of  treatment. 
The  componnd  tincture  of  Corydalis,  or  compound  syrup  of  Stil- 
lingia,  with  iodide  of  potassium,  may  be  administered  in  the 
usual  doses.  Some  preparation  of  iron  should  be  given  with 
this, — frequently  the  tincture  of  muriate  of  iron  will  answer 
best, — and  if  necessary,  the  bitter  tonics  may  be  added.  Once 
in  a  while  cod-liver  oil  is  of  advantage,  and  occasionally  we  give 
our  patient  Fowler's  solution  of  arsenic,  with  Phytolacca. 

Very  much  depends  upon  keeping  the  eyes  clean,  and  remov- 
ing the  tenacious  secretion  without  causing  pain  and  irritation. 
Hence  the  eyes  should  be  frequently  bathed  during  the  day  with 
warm  water,  or  a  weak  decoction  of  Cornusor  Hydrastis,  keeping 
them  as  entirely  free  from  the  secretion  as  possible.  Glycerine 
answers  a  very  good  purpose  in  some  cases,  usually  combined 
with  an  equal  quantity  of  rose-water,  and  applied  freely. 

The  parts  being  perfectly  cleansed,  we  apply  once  or  twice 
daily,  a  very  small  portion  of  mild  zinc  or  ophthalmic  ointment ; 
or,  instend  of  this,  we  may  use  a  mild  collyrium  of  sulphate  of 
zinc  or  borax,  or  one  or  two  drachms  of  nitrous  ether  and  vin- 
egar in  eight  ounces  of  water,  and  followed  by  the  glycerine 
lotion.  The  application  I  now  place  most  dependence  upon  is 
the  brown  citrine  ointment,  one  part  to  two  or  three  parts  of 
simple  cerate.  In  very  severe  cases,  the  faulty  cilia  may  be  re- 
moved, the  crusts  carefully  taken  oif,  and  the  ulcers  lightly 
touched  with  nitrate  of  silver.  In  the  application  of  warm 
water,  or  the  decoctions  named,  or  to  foment  the  eye,  we  can  ac- 
complish our  purpose  best  by  the  use  of  a  very  soft  sponge. 


432  DISEASES   OF  CHILDREN. 

Counter-irritation  to  the  nape  of  the  neck,  or  behind  or  before 
the  ears,  with  the  blister  or  irritating  plaster,  is  often  of  great 
advantage. 

CATARRHAL    CONJUNCTIVITIS. 

The  conjunctiva  covering  in  the  globe  of  the  eye,  and  lining 
the  lids,  is  exquisitely  sensitive,  and  though  abundantly  protect- 
ed, is  frequently  exposed  to  the  causes  of  inflammation.  Tempo- 
rary inflammation  is  often  seen  as  the  result  of  dirt  or  sand  in  the 
eye,  or  even  exposure,  but  very  soon  disappears  with  rest.  The 
disease  we  are  now  describing  may  arise  from  cold,  sudden 
changes  of  temperature,  extension  of  inflammation  from  the 
mucous  membrane  of  the  nose,  or  from  inoculation  with  the 
secretion  of  a  diseased  eye.  This  last  cause  should  be  carefully 
guarded  against,  as  we  not  unfrequently  observe  whole  families 
attacked  with  the  disease  from  the  indiscriminate  use  of  towels. 

Symptoms. — The  disease  commences  with  a  sensation  of  dry- 
ness and  smarting  of  the  eyelids,  with  a  feeling  as  if  dirt  or  sand 
had  got  into  the  eye,  and  it  is  with  difficulty  that  the  patient 
gives  up  this  idea,  the  impression  is  so  strong.  In  a  short  time 
the  eyes  seem  tumid  and  swollen,  the  unpleasant  sensations  have 
increased,  and  a  more  or  less  abundant  secretion,  sometimes 
opaque  and  puriform,  is  established.  If  the  eyes  are  now  exam- 
ined, the  palpebral  conjunctiva  will  be  found  red,  and  swollen, 
and  more  or  less  reticular  redness  of  the  ocular  conjunctiva.  As 
the  inflammation  progresses,  the  last  portion  of  the  conjunctiva 
becomes  more  completely  involved,  and  we  sometimes  observe 
ecchymosis  or  extravasated  blood  under  it.  In  a  still  severer 
form  the  conjunctiva  is  remarkably  injected  and  swollen  to  the 
point  where  it  passes  into  the  cornea,  so  much  so  occasionally  as 
to  partially  cover  up  this  part  of  the  eye;  this  swelling  is  termed 
chemosis.  Catarrhal  ophthalmia  is  frequently  periodic,  the  exacer- 
bation always  occurring  in  the  evening,  and  sometimes  attended 
with  headache ;  the  pain  and  itchiness  cease  a  short  time  after 
going  to  bed,  and  the  patient  sleeps  well,  but  it  re-appears  in  the 
morning  on  attempting  to  use  the  eyes. 

In  many  cases  the  disease  continues  thus  for  a  week  or  ten 
days,  and  then  gets  well  without  further  change ;  but  in  some 
cases  it  is  more  persistent.     Sometimes  we  notice  a  smnll  blister 


CATARRHAL   CONJUNCTIVITIS.  433 

on  the  ocular  conjunctiva,  which  rupturing  forms  an  ulcer, 
constantly  throwing  off  an  abundant  puriform  secretion  ;  it  may 
attain  the  size  of  a  half-dime,  or  be  even  larger  than  this,  and  is 
usually  very  painful.  The  cornea  is  sometimes  obscured  and 
hazy  from  tire  inflammation,  and  in  that  variety  of  the  disease 
termed  phlyctenular  has  a  tendency  to  ulcerate.  This  last  form 
of  the  disease  occurs  most  frequently  in  children  and  young 
persons,  and  is  usually  connected  with  a  scrofulous  constitution. 
The  symptoms  are,  marked  pain  and  intolerance  of  light,  free 
secretion  of  tears,  deep  redness  of  the  eyelids,  but  slight  of  the 
ocular  conjunctiva,  sometimes  but  three  or  four  vessels  being 
seen  to  pass  across  to  the  cornea.  Soon  we  notice  the  produc- 
tion of  one  or  more  blisters  on  the  cornea,  which  discharging, 
forms  an  ulcer ;  this  may  increase  in  size  until  it  involves  a  con- 
siderable portion  of  the  cornea,  or  it  may  rapidly  increase  in  depth 
until  it  perforates  it,  and  causes  a  discharge  of  the  aqueous 
humor.  In  some  of  these  cases,  the  phlyctenula  are  absorbed, 
leaving  a  small,  white  spot,  called  albugo;  or  a  cicatrix  results 
from  the  ulceration;  called  leucoma.  If  the  ulcer  penetrates  the 
cornea,  the  iris  is  almost  always  thrown  forward  by  the  escape 
of  the  aqueous  humor,  and  passing  into  the  opening  becomes 
adherent,  and  is  termed  synechia  anterior. 

Diagnosis. — Catarrhal  conjunctivitis  is  usually  recognized  with 
ease;  the  inflammatory  action  commencing  in  the  palpebral  con- 
junctiva, and  subsequently  extending  to  the  ocular  portion, 
with  secretion  of  muco-pus,  are  the  characteristic  symptoms.  In 
phlyctenular  ophthalmia,  there  is  inflammation  of  the  conjunc- 
tiva, but  the  disease  is  principally  confined  to  the  cornea  ;  the 
appearance  of  the  small  vesicles  or  ulcers  in  the  cornea  marks 
the  distinction.  That  form  described  as  pustular,  is  marked  by 
the  formation  of  pustules,  terminating  in  ulcers  in  the  ocular 
conjunctiva  near  the  cornea. 

Prognosis. — In  the  milder  forms  of  catarrhal  ophthalmia  we 
usually  succeed  in  arresting  the  disease  in  a  week  or  ten  days, 
but  if  allowed  to  progress  or  badly  treated,  it  may  endanger  the 
integrity  of  the  eye  and  last  for  months.  The  phlyctenular 
form  is  more  difficult  to  treat  and  not  unfrequently  leaves  the 
marks  already  mentioned.  Pustular  ophthalmia  is  usually  very 
perverse,  but  with  care  may  be  managed  so  as  to  leave  no  bad 
28 


434  DISEASES  OF   CHILDREN. 

result.  Either  of  these  forms  may  become  chronic,  and  develop 
structural  change  which  will  impair  vision  to  a  greater  or  less 
extent. 

Treatment. — The  treatment  of  inflammation  of  the  eyes  will 
be  conducted  on  the  same  general  principles  that  govern  our 
therapeutics  in  all  forms  of  inflammation.  Though  the  part  in- 
volved is  but  small,  it  requires  exactly  the  same  general  means 
as  if  it  were  an  entire  lung  or  other  large  organ.  Remedies,  also, 
will  be  found  just  as  definite  in  their  action,  and  as  prompt  in 
arresting  the  inflammatory  process. 

The  patient  has  the  indicated  sedatives.  Aconite  or  Veratrum 
gtt.  V.  to  a  half  glass  of  water,  a  teaspoonfiil  every  hour.  Other 
remedies  are  given  according  to  the  indications.  Rhus  if  there 
is  burning  pain  in  the  eyes,  or  sharp  pulse  with  frontal  headache ; 
Gelseminum  if  there  is  flushed  face  and  active  circulation  to  the 
brain  ;  Belladonna  if  there  is  dullness  and  capillary  congestion  ; 
Bryonia  if  there  is  tensive  pain  in  the  eye  and  through  the  orbits; 
Apocynura  if  the  lids  are  markedly  swollen  (oedematous)  ;  Phy- 
tolacca if  the  cervical  glands  are  involved  or  there  are  phlyc- 
tenulse. 

Occasionally  a  very  foul  tongue  with  sense  of  oppression  will 
call  for  an  emetic,  or  full  veins  and  full  tissues  generally  will  want 
Podophyllin.  The  simple  pallid  tongue  wants  a  salt  of  soda; 
the  broad,  pallid,  dirty  tongue,  sulphite  of  soda ;  the  red  dirty 
tongue,  sulphurous  acid. 

In  malarial  regions  the  frequent  necessity  for  antiperiodics 
will  be  noted,  and  many  times  they  will  serve  quite  as  good  a 
purpose  as  in  other  diseases  with  periodic  complications.  I  have 
seen  a  conjunctivitis  arrested  in  a  couple  of  days  with  quinine 
alone.  In  some  cases  Alstonia  will  prove  a  good  remedy. 
When  antiperjodics  cannot  be  given  by  mouth,  quinine  can  be 
used  by  inunction. 

The  first  five  days  the  patient  should  be  kept  in  a  darkened 
room,  and  when  exercise  is  taken,  the  eyes  should  be  well 
shaded.  It  is  of  especial  importance  that  the  nervous  system  be 
kept  quiet,  and  fretfulness  and  crying  prevented  ;  this  will  re- 
quire considerable  care  and  management  upon  the  part  of  the 
mother. 

Various  collyria  are  recommended,  in  fact  so  many  that  the 
young  practitioner  does  not  know  which  to  select.     T^  Atropia 


OPACITY   OF   THE  CORNEA.  435 

gr.  i,  water  5j.  ;  ^  Sulphate  of  Morphia  grs.  ij.,  Aromatic  Sul- 
phuric Acid  gtt.  X.,  distilled  water  Sij.  ;  or  ^t.  Tincture  of  Bella- 
donna gtt.  X,;  Tincture  of  Gelseminum  5ss.,  water  §ij.;  dropping 
it  in  the  eye  every  three  or  four  hours.  Associated  with  this,  if 
the  case  is  acute,  I  direct  that  the  eye  be  fomented  with  hot 
water,  a  piece  of  very  soft  sponge  being  used  to  make  the  appli- 
cation. In  some  cases  a  poultice  of  equal  parts  of  Hydrastis 
and  Ulraus,  answers  a  good  purpose,  but  I  now  prefer  the  fomen- 
tation. In  all  cases  the  patient  should  be  kept  perfectly  still; 
in  a  darkened  room,  and  use  a  light  and  easily  digested  diet. 
Mackenzie  strongly  recommends  the  use  of  a  solution  of  nitrate 
of  silver,  gr.  iv.  to  water  .3J. ;  a  large  drop  being  applied  to  the 
eye  two  or  three  times  daily.  For  a  few  minutes  the  eye  feels 
easy,  and  then  for  ten  minutes  there  is  a  sharp  pricking  pain, 
which  subsiding  leaves  the  eye  almost  free  from  pain  for  five 
or  six  hours,  when  the  application  should  be  repeated.  Dr. 
Williams  recommends  a  solution  of  sulphate  of  zinc  in  rose-water 
in  the  proportion  of  from  two  to  four  grains  to  the  ounce. 

OPACITY    OF    THE    CORNEA. 

Opacities  of  the  cornea  are  distinguished  by  different  names, 
according  to  their  density  and  the  character  and  situation  of  the 
lesion.  Nebula  is  the  slightest  degree,  and  is  most  generally 
situated  in  the  superficial  layers,  though  occasionally  deep  seated  ; 
sometimes  it  is  general,  and  is  the  result  of  pressure,  or  of  serous 
effusion  into  the  substance  of  the  cornea.  Albugo  is  that 
form  of  opacity  in  which  the  spot  has  a  pearly  appearance,  and 
generally  results  from  effusion  of  plastic  lymph  in  the  anterior 
layers  of  the  cornea.  It  usually  results  from  the  phlyctenula 
which  have  receded  without  bursting.  Leucoma  is  an  opaque 
cicatrix  closing  an  ulceration ;  it  has  usually  a  contracted  and 
circumscribed  appearance,  and  is  depressed  in  its  center. 

Treatment. — "All  the  three  kinds  of  speck — nebula,  albugo 
and  leucoma — have  a  natural  tendency  to  disperse  as  soon  as  the 
disease  giving  rise  to  them  subsides  or  is  removed,  and  whether 
they  depend  on  primary  inflammation,  spreading  to  the  cornea, 
or  secondary  inflammation  of  that  part  arising  from  the  irritation 
of  inverted  eyelashes  or  granular  conjunctiva.  We  must,  then, 
in    every    case,    endeavor   to   remove   the   ophthalmia    or   the 


436  DISEASES   OF  CHILDREN. 

mechanical  irritation  on  which  the  opacity  depends,  assured  that 
if  we  succeed  in  this,  nature,  by  the  process  of  absorption,  will 
accomplish  the  whole  amount  of  recovery  which  is  possible.  In 
children  and  young  persons  many  very  dense  and  extensive 
opacities  are  removed  in  the  natural  process  of  growth,  which 
would  be  quite  immovable  in  adult  life."     (Mackenzie.) 

Patience  and  perseverance  are  the  great  elements  of  success  in 
these  cases,  and  abundant  time,  from  three  months  to  as  many 
years,  is  necessary  to  the  accomplishment  of  the  purpose.  The 
inflammation  should  be  entirely  removed  in  the  manner  hereto- 
fore named,  and  if  the  person  is  scrofulous  this  should  be  coun- 
teracted as  much  as  possible  and  the  general  health  improved. 
Frequently  this  is  all  that  is  necessary,  the  opacity  disappearing 
as  the  inflammation  is  removed.  If  after  this  we  deem  it  neces- 
sary, we  prescribe  a  mildly  stimulant  collyrium,  as  wine  of 
opium,  pure  or  diluted  ;  Common  salt  grs.  ij.  to  grs.  x.,  to  water 
5j. ;  or  a  solution  of  sulphite  of  soda  grs.  ij.  to  grs.  v.,  to 
water  5j.  Sulphite  or  sulphate  of  soda,  very  finely  powdered,  a 
small  portion  dropped  in  the  eye  once  or  twice  a  day,  is  some- 
times an  excellent  stimulant,  and  the  eye  clears  up  under  its  use. 
In  other  cases,  all  that  is  necessary  is  to  give  nature  sufficient  time 
to  remove  the  deposit ;  and  to  prevent  injurious  meddling  with 
the  eyes,  we  will  in  these  cases  prescribe  some  mild  and  grateful 
application  simply  to  occupy  the  attention  of  the  patient  and 
prevent  discouragement. 


CHAPTER     XI. 
DISEASES    OF    THE    EARS. 


Disease  of  the  ears  is  of  more  frequent  occurrence  in  the  child 
than  in  the  adult;  and  partial  deafuess,  annoying  the  person  for 
a  lifetime,  frequently  has  its  origin  in  early  life.  Some  of  these 
affections  are  marked  by  prominent  symptoms,  while  others  are 
very  obscure,  and  run  their  course  many  times  without  being 
recognized. 

Diseases  causing  structural  change  arise  mostly  from  two 
causes — the   scrofulous   constitution,   or  an  impairment  of  the 


DISEASES   OF  THE   EARS.  437 

blood  following  the  eruptive  fevers.  In  either  case  the  consti- 
tutional disease  must  be  recognized,  and  remedies  directed  to  it, 
if  we  are  to  expect  success. 

The  symptoms  of  disease  of  the  ears  are  those  of  unpleasant  or 
painful  sensations,  discharges  from  the  ears,  and  deafness.  The 
infant  expresses  its  suffering  in  these  cases  by  frequent  move- 
ment of  the  head,  carrying  the  hand  to  the  affected  part,  rubbing 
the  side  of  the  head  on  the  pillow,  or  the  mother's  arm,  and  a 
peculiar  contraction  of  the  facial  muscles  of  that  side. 

If  there  is  pain,  as  from  neuralgia  or  inflammation,  the  child 
is  restless  and  fretful,  crying  out  suddenly  and  piercingly,  and 
at  an  advanced  age  sobbing  during  sleep. 

Examination  of  the  Ear. — The  majority  of  persons  fail 
in  their  examination  of  the  ear  from  defective  light,  or  the  want 
of  ability  or  means  to  use  it.  I  have  seen  professed  aurists  make 
the  most  lamentable  failures  here,  though  working  with  fine 
and  costly  apparatus. 

The  means  are  very  simple,  as  is  the  use.  We  require  sun- 
light or  a  good  lamp,  an  ordinary  toilet  mirror,  and  an  ear 
speculum.  Of  the  last  there  are  several  kinds,  and  most  persons 
who  use  them  express  a  preference  for  the  simple  silver  cylin- 
ders, which  come  in  nests  of  two  or  three.  I  like  the  old-fash- 
ioned bivalve,  as  being  most  readily  employed,  and  adapted  to 
all  ages  and  conditions. 

If  we  have  sunlight,  the  patient  is  placed  so  that  the  ear  to  be 
examined  is  from  the  light,  the  head  at  such  level  that  the  rays  may 
be  readily  thrown  from  the  mirror  to  the  ear.  The  speculum  is 
then  introduced,  and  held  with  one  hand,  while  with  the  mirror  in 
the  other  we  catch  the  rays  of  light  and  throw  them  to  the  bot- 
tom of  the  meatus.  If  we  use  a  lamp,  it  is  set  on  a  table  by  the 
patient's  head,  the  mirror  being  employed  as  before  to  concen- 
trate the  light  and  throw  it  into  the  speculum. 

The  advantages  of  this  method  are  two-fold.  First,  we  em- 
ploy a  larger  volume  of  light,  and  have  greater  command  over 
it,  directing  it  where  and  as  we  choose.  In  the  second  place,  we 
are  able  to  see  the  parts  without  interposing  our  head  between 
the  ear  and  the  light.  Those  who  employ  the  ophthalmoscope 
or  the  laryngoscope,  may  use  the  perforated  mirrors  of  these 
instruments  as  reflectors. 

There  is  no  difficulty  with  these  means  of  making  a  thorough 


438  DISEASES   Oi'"    CIIILDUEN. 

exaniiuatiou  of  the  ear,  even  iu  the  child,  and  of  determining  th^ 
condition  of  the  external  auditory  meatus,  and  membruni  tym- 
paui. 

FOREIGN  BODIES  IN  THE  EAR. 

Children  more  frequently  than  the  adult,  get  foreign  bodies  in 
the  ear.  Often  a  pea,  bean,  grain  of  corn,  or  other  material,  will 
be  introduced  purposely  by  the  child  or  some  companion  in  play. 
Rarely  an  insect  or  other  living  thing  accidentally  gains  en- 
trance, and  causes  considerable  disturbance. 

The  foreign  body  does  not  at  first  produce  any  or  but  little 
unpleasant  feeling,  but  the  efforts  at  removal,  very  often  rou^li, 
excite  the  sensibility  of  the  organ,  and  after  a  time  excite  an  ex- 
treme irritability.  The  history  of  the  case  is  plain,  and  a  sligi.t. 
examination  determines  the  presence  of  the  body. 

Treatment. — There  are  two  methods  of  removal,  both  good, 
wliich  we  choose  to  suit  the  particular  case  in  hand.  The  one 
is,  to  take  a  wire,  and  bend  it  upon  itself,  forming  a  loop,  intro- 
ducing this  by  the  side  of  the  object  until  it  has  passed  clearly 
beyond.  Then  separating  the  strands  of  wire,  they  are  drawn 
gently  forward,  and  catching  the  object  in  the  loop,  it  is  with- 
drawn.    It  is  the  old  plan  of  removing  a  cork  from  a  bottle. 

The  other  plan  is  to  remove  the  foreign  body  by  a  jet  of  water 
thrown  from  a  syringe.  Taking  an  ordinary  hard  rubber  or 
glass  syringe  of  small  size  filled  with  warm  water,  the  jet  is 
thrown  in  the  ear  with  some  force ;  the  rebound  causes  the  de- 
tachment and  removal  of  the  body.  It  is  better  tliat  the  child's 
head  be  placed  in  such  position  that  the  ear  will  be  dependent. 

Under  no  circumstances  should  we  undertake  to  remove  a  for- 
eign body  with  a  scoop,  forceps,  or  like  instruments. 

EARACHE. 

Earache  may  not  strike  the  reader  as  being  worthy  of  much 
study,  as  the  terra  has  little  of  medical  terminology,  and  smacks 
of  the  nursery.  The  ache,  however,  is  a  very  troublesome  real- 
ity, producing  a  very  un]>leasant  commotion  in  the  household, 
and  demanding  speedy  relief 

Causes. — The  cause  of  this  neuralgic  pain  in  the  ear  is  most 
frequently  cold,  though  it  may  be,  in  part,  from  derangement  of 
the  digestive  organs  and  arrest  of  secretion. 


DISEASES    OF    THE    EARS.  439 

Symptoms. — The  child  is  very  restless  aud  uneasy,  moves  its 
head  from  side  to  side,  sleeps  but  little,  and  wakes  with  a  start, 
crying  loudly.  The  pain  is  undoubtedly  paroxysmal  in  character, 
as,  for  a  little  time,  the  child  is  easy,  and  then  breaks  out  in  a 
piercing  cry,  as  if  hurt. 

Sometimes  there  is  slight  febrile  action  with  suffused  eyes, 
stopped  nose,  and  other  evidences  of  cold.  In  some  cases  the 
child^s  face  is  flushed,  and  the  temperature  of  the  affected  side 
increased;  but  at  others  the  face  is  pallid,  the  eyes  dull,  and  the 
patient  evidently  depressed. 

An  examination  of  the  ear  determines  whether  it  is  neuralgia 
or  inflammation.  If  the  first,  there  is  no  swelling,  or  evidence 
of  structural  change,  while  in  inflammation,  the  swelling,  red- 
ness, heat,  and  tenderness  on  pressure,  are  prominent  symp- 
toms. 

Treatment. — When  there  is  excitement  of  the  circulation,  I 
put  the  child  upon  the  use  of  tincture  of  Aconite  in  the  usual 
doses,  adding  Gelseminum  if  there  is  much  irritation  of  the 
nervous  system,  or  Rhus  if  there  is  the  contraction  about  the 
eyes,  and  the  sharp  stroke  of  the  pulse.  If,  on  the  contrary, 
there  is  dullness,  the  face  pale,  the  pupils  dilated,  and  evidently 
a  sluggish  circulation,  Belladonna  should  be  used  with  the 
Aconite.  In  the  last  case  a  full  dose  of  quinia  once  or  twice 
daily,  will  be  an  important  addition  to  the  treatment. 

As  a  local  application  I  generally  prescribe:  ^  Tincture  of 
Aconite,  Tincture  of  Opium,  aa.  5ij-,  Glycerine  .5ss.;  mix.  AVarm 
a  spoon  and  from  it  drop  one  or  two  drops  in  the  ear,  and  also 
apply  it  around  the  ear  with  the  finger.  A  warm  flannel  ap- 
plied over  the  ear  will  complete  the  treatment. 

OTITIS. 

Quite  a  number  of  different  affections  have  been  grouped  to- 
gether under  the  head  of  Otitis,  and  as  they  are  all  inflamma- 
tory, present  similar  symptoms,  and  require  nearly  the  same 
treatment,  it  will  hardly  be  worth  while  to  endeavor  to  make  the 
distinction.  Inflammation  of  the  external  auditory  meatus  and 
cavity  of  the  tympanum  are  usually  produced  by  sudden  changes 
of  temperature,  though  it  may  be  caused  by  the  introduction  of 
irritants,  or  even  from  accumulation  of  cerumen. 


440  DISEASES   OF   CHILDREN. 

Symptoms. — Inflammation  of  the  external'  auditory  meatus 
commences  with  a  feeling  of  stiffness,  fullness,  and  uneasiness 
about  the  meatus,  which  is  increased  when  the  ear  is  pressed 
upon.  In  a  short  time  the  pain  becomes  very  severe,  is  tensive, 
darting,  lancinating,  and  seems  to  affect  the  entire  side  of  the 
head  to  some  extent.  Frequently  there  are  marked  chilly  sen- 
sations with  the  accession  of  the  severe  pain,  and  these  are  fol- 
lowed by  febrile  reaction.  On  examination  we  will  find  the 
lining  membrane  of  the  meatus  tumid  and  red,  sometimes  swol- 
len so  as  almost  entirely  to  close  the  opening.  The  pain  contin- 
uing for  from  two  to  six  days,  secretion  takes  place,  or  pus  is 
formed  and  discharged,  sometimes  in  considerable  quantity.  At 
first  it  is  usually  thick,  but  at  last  is  thin,  and  in  some  cases  is 
secreted  in  very  large  quantity.  The  discharge  continuing  for  a 
short  time,  the  symptoms  of  inflammation  entirely  disappear, 
and  the  part  is  restored  to  its  normal  condition. 

Acute  inflammation  of  the  cavity  of  the  tympanum  is  a  far 
more  serious  affection,  and  may  result  in  permanent  impairment 
of  the  hearing,  or  even  in  death  by  extension  to  the  brain.  In 
children  this  is  usually  very  severe  at  night,  with  comparative 
ease  during  the  day,  though  the  child  is  restless  and  irritable. 
There  is  usually  considerable  fever  at  night,  and  even  during  the 
day  the  skin  is  dry  and  the  pulse  hard. 

Diagnosis. — Inflammation  of  the  ear  presents  such  marked 
symptoms  that  it  is  not  easily  mistaken.  The  severity  of  the 
pain  and  its  location,  and  attendant  constitutional  disturbance, 
are  sufficiently  characteristic.  If  the  external  meatus  is  the  seat 
of  the  disease,  it  will  be  found  red  and  swollen,  as  is  the  case  if 
the  membrana  tympani  is  affected.  If  confined  to  the  cavity  of 
the  tympanum,  all  the  symptoms  are  more  severe  and  there  is 
an  absence  of  external  signs  of  inflammation.  When  the  inflam- 
mation extends  to  the  mastoid  cells,  the  constitutional  disturb- 
ance is  very  marked,  and  when  pus  forms,  the  deep  throbbing 
and  marked  disturbance  of  the  brain  show  tlio  cliaractor  of  the 
lesion. 

Prognosis. — Though  quite  painful,  inflammation  of  the  ex- 
ternal meatus  is  not  dangerous,  nor  attended  with  worse  results 
than  otorrhoea  in  occasional  cases.  If  the  tympanum  is  affected 
there  is  some  danger  of  affection  of  the  brain,  and  considerable 


OTITIS.  441 

of  impairment  of  the  hearing.     Inflammation  of  the  mastoid 
cells,  if  it  progresses  to  suppuration,  is  always  dangerous. 

Treatment. — Put  the  patient  upon  the  use  of  Aconite  or 
Veratrum  in  the  usual  doses,  aiding  the  action  by  the  use  of  the 
hot  foot-bath.  If  there  are  indications  for  other  remedies  these 
may  be  added  to  the  sedative  solution,  or  given  in  alternation. 
We  will  thus  find  in  different  cases  indications  for  Gelseminum, 
Rhus,  Bryonia,  Belladonna,  Apis,  Macrotys,  Phytolacca,  Apocy- 
num,  etc.  In  some  cases — a  full  tongue  heavily  coated — emesis 
will  give  the  speediest  relief.  If  the  tongue  is  pallid  and  dirty, 
give  sulphite  of  soda;  if  red  and  dirty,  sulphurous  acid. 

Locally  we  may  apply  the  lotion  of  Aconite  and  Opium,  here- 
tofore named,  around  the  ear,  and  even  drop  it  into  the  ear. 

This  may  be  followed  by  the  use  of  the  vapor  of  water,  and 
hot  fomentations  of  Stramonium.  Occasionally  much  relief  is 
obtained  from  the  use  of  a  lotion  of  equal  parts  of  tincture  of 
Aconite  and  Belladonna,  applied  around  the  ear.  In  some  cases, 
the  fever  being  very  intense,  we  may  employ  the  vapor  of  tinc- 
ture of  opium,  stramonium,  lobelia,  tobacco,  etc.,  directly  to  the 
external  meatus  and  merabrana  tympani,  by  means  of  a  gutta- 
percha tube.  Chloroform  and  ether  may  be  used  in  the  same 
way,  as  may  also  carbonic  acid  gas. 

With  throbbing  pain  in  the  ear,  we  are  satisfied  that  suppura- 
tion has  occurred,  and  sometimes  an  inspection  of  the  meatus 
will  show  the  yellowish  color  of  pus.  The  little  abscess  should 
be  at  once  opened  with  a  sharp-pointed  bistoury,  when  we  will 
have  immediate  relief. 

If  the  disease  is  of  the  middle  ear,  and  the  pain  becomes 
tensive  and  throbbing,  we  may  be  satisfied  of  the  presence  of  pus. 
An  examination  of  the  ear  will  show  the  membrana  tympani 
pushed  outward  (convex)  and  blanched  and  yellowish.  If  it  is  now 
incised  with  a  small  tenotome,  or  small,  sharp-pointed  bistoury,  the 
escape  of  a  drop  or  two  of  pus  gives  relief  In  place  of  destroy- 
ing the  tympanic  membrane  by  incision,  we  frequently  preserve 
it,  for  the  continuous  presence  of  pus  would  cause  its  entire  de- 
struction, and  sometimes  the  destruction  of  the  internal  mem- 
brana, whilst  if  the  pus  is  discharged,  the  inflammation  ceases, 
and  the  wound  closes  up,  the  membrane  showing  but  a  slight 
cicatrix. 


442  DISEASES   OF   CHILDREN. 

If  the  disease  seems  to  exteud  to  the  mastoid  portion  of  tlie 
boue,  I  should  apply  a  blister  immediately  over  it,  and  follow  it 
with  the  irritating  plaster.  In  some  cases,  suppuration  having 
undoubtedly  taken  place,  and  dangerous  symptoms  occurring,  it 
becomes  necessary  to  open  into  the  mastoid  cells  through  the 
bone,  in  order  to  permit  the  escape  of  pus. 

OTORRHOEA. 

Purulent  discharges  from  the  ear  may  be  occasioned  by  chronic 
inflammation  of  the  external  meatus,  or  disease  of  the  bony 
canal,  or  it  may  "proceed  from  chronic  inflammation  of  the  tym-* 
panum,  or  disease  of  adjacent  parts,  the  membrana  tympani 
having  been  ruptured  or  destroyed,  so  as  to  permit  its  escape. 
In  either  case  there  is  more  or  less  deafness,  uneasiness  in  the 
ear,  and  an  offensive  discharge.  The  most  frequent  causes  of 
otorrhoea  are  inflammation  attending  the  eruptive  fevers,  injuries, 
the  direct  action  of  cold,  and  chronic  inflammation  resulting 
from  acute  attack.  Some  families  seem  to  have  a  predisposition 
to  this  affection,  the  majority  of  their  children  having  such  dis- 
charge. In  such  cases  it  is  almost  always  associated  with  scrofula 
and  feeble  vitality. 

Otorrhoea  from  disease  of  the  external  auditory  meatus  is  the  most 
frequent  form  of  the  affection,  and  might  properly  be  called 
chronic  catarrh.  It  is  of  frequent  occurrence  after  scarlet  fever 
and  measles,  and  is  often  seen  in  infancy  or  up  to  the  age  of  two 
or  three  years,  becoming  more  rare  as  we  advance  to  adult  age, 
except  in  the  cases  named.  It  is  true,  that  the  disease  com- 
mencing at  the  age  of  two  or  three  years  may  continue  through 
life,  biit  this  is  not  very  common  when  the  patient  has  sufiBcient 
vitality  to  reach  adult  age.  Further  than  the  discharge  from 
the  ears  of  an  offensive  purulent  matter,  and  some  dullness  of 
hearing,  there  are  no  prominent  symptoms,  if  we  except  the  al- 
most invariable  cachectic  appearance  of  the  child.  On  examin- 
ing the  ear,  we  will  find  the  bone  in  a  carious  condition.  When 
the  hearing  is  much  affected,  we  will  find  the  membrana  tympani 
opaque,  and  its  dermoid  layer  thick  and  vascular.  In  some 
cases  the  discharge  is  produced  by  a  small  polypoid  formation  in 
the  ear,  and  in  others  by  a  hardened  cerumen. 

Otorrhoea  from  disease  of  the  middle  ear  occurs  only  when  the 
membrana  tympani  has  been  destroyed  or  ruptured,    and  may 


OTOREHCEA.  443 

arise  from  chronic  inflammation  of  the  lining  membrane,  disease 
of  the  ossicles,  or  disease  of  the  bony  walls.  It  is  most  generally 
the  sequence  of  acute  inflammation,  which  terminating  in  sup- 
puration, the  membrana  tympani  gives  way,  and  the  inflamma- 
tion gradually  assumes  the  chronic  form.  There  is  always  deaf- 
ness, sometimes  but  slight,  at  others  marked.  There  may  not  be 
pain  or  unpleasant  sensations  in  the  ear,  though  usually  if  there 
is  but  a  slight  opening  in  the  membrana  tympani  it  occasionally 
becomes  closed,  and  dizziness,  ringing  in  the  ear,  etc.,  result  from 
the  pressure  of  the  retained  secretion. 

The  condition  of  the  tympanum  varies  greatly;  in  some  cases 
there  is  but  slight  change  of  structure,  in  others  the  ossicles  be- 
come diseased,  and  are  cast  off,  the  mastoid  cells  and  eustachian 
tube  are  affected  to  some  extent,  and  the  hearing  is  nearly  en- 
tirely destroyed.  It  may  occasionally  terminate  fatally  by  an 
extension  of  the  inflammation  to  the  membranes  of  the  brain. 

Treatment. — In  all  cases  it  becomes  necessary  to  pay  atten- 
tion to  the  general  health,  for  as  long  as  the  child  or  adult  con- 
tinues cachectic,  or  shows  evidence  of  a  wrong  of  the  blood,  it 
is  almost  impossible  to  arrest  the  discharge.  The  use  of  lime 
water,  sulphite  of  soda  if  there  is  eczema,  sulphurous  acid,  cod 
liver  oil,  arsenic,  iodide  of  potash,  Donovan's  Solution,  Phyto- 
laca,  and  some  of  the  vegetable  alteratives,  are  suggested.  It  is 
impossible  to  name  a  remedy  which  will  be  good  in  all  cases,  for 
here,  as  in  other  diseases,  the  remedy  will  be  selected  according 
to  the  special  indications  in  the  case. 

Prominent  among  external  applications  in  all  forms  of  this 
affection,  except  when  occassioned  by  a  foreign  body  lodging  in 
the  ear,  or  a  polypoid  growth,  is  counter-irritation  over  the  mas- 
toid process.  It  should  rarely  be  neglected,  but  pursued  stead- 
ily until  the  cure  is  complete.  The  best  agent  that  I  have  em- 
ployed is  the  cautharides,  which  may  be  repeated  sufficiently 
often  to  keep  up  a  continued  influence. 

In  common  chronic  inflammation  of  the  external  meatus, 
washing  the  ear  out  thoroughly  with  tepid  water,  and  dropping 
three  or  four  drops  of — I^  Tinct  of  muriate  of  iron  5ij.,  glyce- 
rine Sj.,  into  the  ear  once  or  twice  daily,  will  eff^ect  a  cure  in  one 
or  two  weeks.  In  place  of  this,  nitric  acid  gtt.  x.,  to  water  and 
glycerine  aa.  .^ss.,  may  be  employed  with  advantage.  A  weak 
solution   of  thymol,  of  sulphate   of  zinc,  or    acetate   of  lead, 


444  DISEASES   OF    CHILDREN. 

from  four  to  ten  grains  to  the  ounce  of  water,  may  be  used  in 
some  cases.  1^  Chlorate  of  potassa,  gr.  xx.,  glycerine  3ss., 
water  5j.,  also  forms  a  good  application.  An  infusion  of  Haraa- 
melis,  Hydrastis,  Cornus,  Geranium,  Sage,  etc.,  is  found  use- 
ful in  some  cases.  Occasionally  I  have  employed  oxide  of  zinc 
gr.  X.,  rubbed  up  with  glycerine  5ss.,  adding  a  small  portion 
of  morphia  if  necessary,  to  relieve  irritation. 

Failures  in  these  cases  will  frequently  depend  upon  a  faulty 
use  of  local  means.  When  injections  are  used  they  do  not  reach 
the  affected  surfaces.  In  place  of  the  syringe,  a  long  camel's 
hair  pencil  may  be  used  to  clean  the  ear  first,  and  afterward  to 
carry  the  local  remedy  close  to  the  membrana  tyrapani  if  neces- 
sary. This  will  be  readily  done  by  twirling  the  pencil  between 
the  fingers  as  it  is  introduced. 

In  some  cases  the  brown  citrine  ointment,  with  one  to  three 
parts  of  cod  liver  oil  or  simple  cerate  (according  to  the  soreness), 
may  be  applied  to  the  entire  diseased  surface  by  twisting  a  soft 
piece  of  cotton  cloth,  smearing  it  with  the  ointment,  and  twist- 
ing it  as  it  is  pressed  into  the  meatus.  In  other  severe  cases, 
nitric  acid  applied  lightly  with  the  pine  pencil,  will  be  found  a 
most  excellent  plan  of  treatment. 

If  the  tympanic  cavity  is  the  seat  of  disease,  we  will  pay  espe- 
cial attention  to  the  general  health,  and  keep  up  continuous 
counter-irritation  near  the  ear.  Cleanliness  is  of  prime  impor- 
tance, and  hence  the  ear  should  be  thoroughly  washed  out,  once 
or  twice  daily.  This  may  be  followed  by  some  of  the  lotions 
above  named,  being  careful  that  they  are  brought  in  contact 
with  the  diseased  surface. 

If  the  discharge  is  produced  by  accumulations  of  hardened 
cerumen  acting  as  a  foreign  body,  this  should  be  softened  and 
removed  with  a  scoop.  If  from  a  polypus,  and  it  is  not  red  and 
vascular,  it  may  fi'equeutly  be  removed  by  the  application  of  a 
saturated  solution  of  tannin,  or  the  careful  application  of  chloride 
of  zinc.  The  best  plan,  however,  in  all  cases,  is  to  catch  it  with  a 
strong  pair  of  ring  forceps,  and  detach  and  remove  it. 

DEAFNESS. 

Partial  loss  of  hearing  depends  upon  various  causes,  some  of 
which  are  remediable  ;  total  deafness  depends  upon  disease  of  the 
internal  ear,   and  if  of  any  considerable  duration  is  incurable. 


DEAFNESS.  445 

We  wish,  therefore,  in  this  place,  to  inquire  into  the  causes  of 
partial  deafness,  and  see  how  far  they  are  amenable  to  treatment. 
We  may  sum  them  up,  as :  1st,  from  disease  of  the  external 
meatus;  2d,  from  disease  of  the  membrana  tympani ;  3,  from 
disease  of  the  tympanum ;  and,  4th,  from  disease  of  the  eusta- 
chian tube.  Diseases  of  the  internal  ear  are  beyond  our  powers 
of  diagnosis,  though  we  are  able  occasionally  to  determine  with 
considerable  certainty  that  the  deafness  is  dependent  upon  par- 
tial paralysis — we  call  this  nervous  deafness.  The  ear-specu- 
lum should  always  be  used,  so  as  to  make  an  accurate  diagnosis. 

1.  The  external  meatus  suffering  from  chronic  inflammation 
will  give  rise  to  hardness  of  hearing,  as  we  have  already  seen. 
In  other  cases  the  lining  membrane  is  thickened  and  dry,  and 
in  addition,  the  ceruminous  glands  seem  to  pour  out  a  very  in- 
spissated secretion,  which  desiccating  sometimes  fills  up  the  bot- 
tom of  the  meatus.  In  this  case  Ave  would  use  injections  of 
tepid  water  and  the  scoop,  to  thoroughly  cleanse  the  ear,  and 
then  use  the  lotion  of  tincture  of  muriate  of  iron  and  glycerine, 
heretofore  mentioned.  The  lotion  of  thymol  and  glycerine  may 
also  be  used  in  these  cases.  If  there  is  irritation  of  the  struc- 
tures, much  benefit  will  be  derived  from  counter-irritation  over 
the  ear.  Polypi  obstructing  the  meatus  should  be  removed,  as 
before  mentioned. 

2.  A  condition  of  chronic  inflammation  of  the  membrana 
tympani,  giving  rise  to  a  fleshy  vascular  appearance  when  ex- 
amined with  the  speculum,  is  sometimes  a  cause  of  deafness; 
quite  frequently  it  is  associated  with  catarrhal  inflammation  of 
the  meatus,  though  it  may  persist  afterward.  An  injection  of  a 
decoction  of  Cornus  and  Hydrastis,  and  the  local  application  with 
a  camel's  hair  pencil  of  the  oxide  of  zinc,  morphia,  and  glyce- 
rine, heretofore  named,  is  usually  sufficient.  Counter-irritation 
over  the  mastoid  process  is  also  employed.  Relaxation  of  the 
membrana  tympani  is  not  of  frequent  occurrence,  but  may  occa- 
sionally be  met  with  as  a  cause  of  deafness.  It  is  readily  de- 
termined by  the  use  of  the  speculum,  the  membrane  being  re- 
markably concave  on  its  external  face,  and  is  diagnosed  from 
the  same  appearance  resulting  from  closure  of  the  eustachian 
tube,  by  its  being  thrown  outward  by  swallowing  with  closed 
nostrils.  Pond's  Hamamelis  and  glycerine,  equal  parts,  make  a 
good  local  application.  Tincture  muriate  of  iron  5j-  to  glyce- 
rine .5j.  maybe  used  in  some  cases,  and  a  solution  of  Hydrastia, 


446  DISEASES   OF   CHILDREN. 

gr.  ij.  to  rose-water  Sjv  will  give  tone  to  the  structures  in  others. 
Perforation  of  the  membrana  tympani  is  a  frequent  cause  of 
deafness,  and  is  readily  detected  with  the  speculum.  It  seems, 
however,  that  the  deafness  depends  in  part  upon  thickening  of 
the  mucous  membrane  of  the  tympanic  cavity,  for  when  this  is 
marked,  the  patient  can  hardly  hear  at  all,  while  in  other  cases 
the  deafness  is  but  slight.  We  should  therefore  endeavor  to  re- 
move all  irritation  by  the  use  of  counter-irritants  and  appropri- 
ate local  applications,  and  we  will  then  have  placed  the  patient 
in  the  best  condition  for  the  use  of  the  artificial  membrana  tym- 
pani ;  this  is  formed  out  of  vulcanized  rubber,  and  has  been  very 
successfully  employed. 

3.  Various  changes  in  the  tympanic  cavity,  resulting  from  in- 
flammation, may  be  the  cause  of  deafness,  but  there  is  only  one, 
so  far  as  we  know,  that  can  be  reached  by  remedial  measures. 
We  have  already  noticed  that  a  chronic  inflammation  of  these 
structures  might  continue  for  years,  attended  with  secretion ; 
and  examination  shows' us  in  some  cases,  a  thickening  of  the 
lining  membrane,  with  increased  vascularity.  In  these  cases, 
the  persistent  use  of  counter-irritation  and  the  local  means  here- 
tofore named  will  do  much  toward  the  relief  of  the  deafness. 

4.  Obstruction  of  the  eustachian  tube  always  gives  rise  to 
partial  deafness,  though,  as  the  causes  are  usually  temporary,  the 
deafness  is  not  of  long  duration.  Dr.  Toynbee  notices  three 
points  of  obstruction  :  1,  at  its  faucial  orifice,  a  thickening  or 
relaxation  of  the  mucous  membrane ;  2,  at  its  tympanic  orifice, 
from  thickening  of  the  mucous  membrane,  or  a  deposit  of  fibrin ; 
3,  in  the  middle  part  of  the  tube,  from  a  collection  of  mucus,  a  stric- 
ture of  the  osseous  or  cartilaginous  portions,  or  membranous 
bands  connecting  the  walls.  If  the  eustachian  tube  is  impervious, 
we  will  find  the  membrana  tympani  sunken  in,  of  a  dull,  leaden 
hue,  and  its  surface  unnaturally  glossy,  and  swallowing  with 
the  nose  closed  or  forcible  expiration  will  not  have  any  effect 
on  it. 

If  the  patient  has  had  disease  of  the  tonsils,  fauces,  or  poste- 
rior nares,  we  may  reasonably  suppose  that  the  disease  has  been 
caused  by  this,  and  is  at  the  faucial  extremity  of  the  tube.  Tlie 
inflammation  sometimes  extends  to  the  mucous  membrane  lining 
the  tube,  and  its  tumefaction  causes  the  disease.  In  other  cases 
the  swelling  of  the  mucous  membrane  at  the  termination  of  tlie 
tube,  is  the  cause  of  it,  and  in  another  class  it  results  from  re- 


DEAFNESS.  447 

laxation.  In  these  cases,  appropriate  measures  to  relieve  in- 
flammatory engorgement  in  tlie  one  instance,  and  to  remove  the 
atony  and  relaxation  in  the  other,  should  be  adopted.  The  ori- 
fice of  the  eustachian  tube  may  be  reached  through  the  mouth 
or  inferior  meatus  of  the  nose,  and  local  applications  may  be 
made  with  a  probang  or  syringe.  In  some  cases  it  is  proposed 
to  remove  obstructions  by  means  of  a  probe  passed  into  the 
eustachian  tube,  but  no  perjnanent  benefit  results  from  it.  We 
may,  however,  introduce  a  catheter,  for  the  purpose  of  using  an 
injection  into  the  tube,  using  the  same  remedies  that  would  be 
indicated  in  other  situations,  as,  for  instance,  those  recommended 
in  otorrhoea. 

Nervous  Deafness. — Toynbee  remarks  that  "As  some  cases 
of  deafness  dependent  upon  the  derangement  of  the  nervous 
apparatus  connected  with  the  organs  of  hearing  appear  to  be 
caused  by  the  condition  of  the  brain  generally,  or  of  that  part  in 
intimate  relation  with  the  acoustic  nerve,  it  has  seemed  desira- 
ble to  divide  the  nervous  diseases  of  the  ear  into  two  classes ;  to 
the  first  of  which  belong  those  cases  where  the  special  nervous 
apparatus  of  the  organ  is  alone  aifected ;  to  the  second,  those 
"where  the  brain,  conjointly  with  the  ear,  seems  to  be  injured. 
The  first  class  may  be  divided  into  diseases  arising  from :  1, 
concussion  ;  2,  the  application  of  cold ;  3,  various  poisons,  as 
that  of  typhus,  scarlet,  or  rheumatic  fevers,  of  measles  and 
mumps,  of  gout,  of  an  accumulation  of  bile  in  the  blood,  and  of 
quinine  in  large  doses.  And  the  second  into  diseases  arising 
from:  1,  excess  of  mental  excitement;  2,  physical  debility. 

In  the  first  class  of  cases  there  is  not  unfrequently  ringing  and 
singing  in  the  ears,  with  other  morbid  sounds,  and  sometimes  a 
feeling  of  giddiness  and  unsteadiness  extremely  unpleasant. 
From  its  commencement  there  is  frequently  a  continuous  in- 
crease in  the  deafness;  but  in  other  cases  it  remains  the  same, 
and  in  still  others  there  is  gradual  improvement.  It  is  gener- 
ally conceded  that  in  very  many  cases  there  is  congestion  of  the 
nervous  apparatus  of  the  internal  ear,  though  if  it  continues  for 
a  considerable  time  it  will  very  likely  terminate  in  structural 
change. 

The  treatment  will  vary  in  these  cases,  in  some  the  remedies 
being  selected  from  tho.se  which  influence  the  nervous  system  di- 
rectly, in  others  from  those  which   influence  the  blood,   and   in 


448  DISEASES  OF  CHILDREN. 

still  others  from  those  which  influence  waste  and  excretion.  Of 
the  first  class  we  find  marked  benefit  from  Rhus,  Bryonia,  Sticta, 
Belladonna,  Apocynum,  Bromide  of  Potash,  Bromide  of  Ammo- 
nium, etc.  Of  the  second.  Fowler's  Solution  of  Arsenic,  Cod 
liver  Oil,  Donovan's  Solution,  Phytolacca,  Alnus.  The  third 
class  will  embrace  the  alkaline  diuretics,  and  remedies  that 
increase  secretion  from  skin  and  bowels. 

Persistent  counter-irritation  over  the  mastoid  portion  of  the 
temporal  bone,  with  cantharides,  or  the  irritating  plaster,  is  one 
of  the  most  important  parts  of  the  treatment.  These  measures, 
followed  up  for  months,  will  occasionally  produce  the  most 
marked  benefit,  the  hearing  being  sometimes  completely  re- 
stored ;  but  in  other  cases  no  benefit  results. 

In  the  second  class  of  cases  we  will  have  more  or  less  evidence 
of  cerebral  disturbance,  though  frequently  the  symptoms  are  im- 
perfectly marked.  No  treatment  can  be  laid  down  for  these 
cases,  as  the  symptoms  are  so  variable  and  changing.  They 
should  be  treated  on  general  principles,  and  we  will  sometimes 
be  agreeably  surprised  at  a  favorable  termination  in  cases  which 
had  seemed  hopeless;  and  not  unfrequently  we  will  fail  when  we 
seemed  to  have  the  best  chance  of  success. 


CHAPTER    XII. 
DISEASES    OF    THE    SKIN. 


Difficult  of  classification  in  all  cases,  we  find  diseases  of  the 
skin  doubly  so  in  the  child.  True,  some  cases  are  so  well  de- 
fined that  the  merest  tyro  will  assign  them  their  proper  place  ; 
but  others  are  obscure  from  the  first,  and  more  become  so  as 
they  progress. 

Probably^  the  simplest  classification  is  that  adopted  by 
Cazenave,  into  eight  orders.  The  following  brief  description  of 
each  will  enable  the  reader  to  classify  many  /bases  : 

Exanthemata. — This  term  is  applied  to  patches  of  a  reddish 
color,  varying  in  intensity,  size  and  form,  disappearing  under 
pressure  of  the  finger,  and  terminating  in  delitescence,  resolu- 
tion or  desquamation. 


DISEASES  OF   THE  SKIN.  449 

Vcsfcalce. — A  vesicle  is  a  slight  elevation  of  the  epidevniis, 
contain ing  a  serous  and  transparent  fluid,  which,  however,  is  oc- 
casionally opaque  or  sero-purulent.  The  vesicle  may  terminate 
in  ahsorption  of  the  fluid,  slight  desquamation,  excoriation,  or 
the  formation  of  small,  thin  incrustations. 

Bullae. —  Generally  speaking  bullfe  differ  from  vesiculse  merely 
in  size;  they  are  small  superficial  tumors  caused  by  effusion  of 
serum  underneath  the  epidermis. 

Pustulce. — This  term  should  be  strictly  confined  to  circum- 
scribed collections  of  pus  on  the  surface  of  the  inflamed  mucous 
layer.  The  contents  of  the  pustules  in  drying  produce  scales, 
and  they  may  be  followed  by  chronic  induration,  or  by  red  in- 
flamed surfaces,  or  sometimes  by  slight  excoriation. 

Papulae. — These  are  small  elevations,  which  are  solid,  resist- 
ing, and  never  contain  any  trace  of  fluid  ;  they  may  likewise  give 
rise  to  ulceration,  but  generally  terminate  in  resolution  and 
furfuraceous  desquamations. 

Squamcc. — The  term  squamre  is  apj)lied  to  the  scales  of  thick- 
ened, dry,  whitish,  friable,  and  degenerated  epidermis,  which 
cover  minute  papular  elevations  of  the  skin  ;  they  are  easily  de- 
tached, and  may  be  reproduced  for  an  indefinite  length  of  time 
by  successive  desquamations. 

Tuberculae. — These  are  small  hard  tumors  more  or  less  promi- 
nent, circumscribed  in  form,  and  persistent ;  they  may  become 
ulcerated  at  the  summit,  or  suppurate  partially.  In  this  defini- 
tion we  consider  tubercles  as  elementary  lesions,  and  not  those 
which  appear  after  abscesses. 

3Iaculcc — Are  permanent  chan-ges  in  color,  in  certain  points 
of  the  skin,  or  of  the  whole  cutaneous  envelope,  but  unattended 
with  any  general  derangement  of  the  health. 

ORDER    I.-EXANTHEMATA. 

The  genei?al' characteristics  of  this  order  are  well  marked  at 
first,  though  in  the  progress  of  the  disease  they  may  so  change 
that  they  will  approximate  some  of  the  others.  They  always 
commence  with  redness  of  the  skin,  M'hich  is  effaced  for  the 
moment  by  pressure,  returning  as  soon  as  this  is  removed. 
Some  of  them,  as  erysijjelas,  rubeola  and  scarlatina,  are  attended 
29 


450  DISEASES   OF   CHILDREN. 

with  marked  constitutional  disturbance,  and  in  the  last  two,  as 
we  have  already  seen,  the  cutaneous  disease  is  associated  with 
disease  of  the  throat  and  respiratory  apparatus,  and  in  all  three 
of  the  diseases  named  there  is  in  some  cases  marked  lesion  of  the 
blood.  -^ 

ERYTHEMA. 

Erythema  is  one  of  the  mildest  of  the  exanthemata,  and  usu- 
ally >is  not  accompanied  with  febrile  action,  though  in  the 
severer -^jases  there  is  arrest  of  secretion  and  some  constitutional 
disturbance.  It  may  be  produced  from  mechanical  irritation  of 
the  skin,  but  the  most  frequent  causes  are  cold  and  arrest  of 
cutaneous  secretion,  or  gastric  and  intestinal  derangements. 

Symptoms. — The  disease  appears  in  the  form  of  patches  of 
variable  size,  of  a  light,  superficial  red  color,  readily  effaced  by 
pressure,  and  most  frequently  on  the  face,  chest  and  limbs.  In 
some  cases  they  spread  so  as  to  cover  a  considerable  portion  of 
the  body,  but  this  is  not  frequent.  One  form,  termed  erythema 
nodosum,  is  preceded  by  slight  constitutional  disturbance,  and 
comes  out  in  oval,  red  patches,  from  half  an  inch  to  an  inch  in 
diameter,  most  generally  on  the  lower  extremities.  When  more 
fully  developed  they  are  slightly  elevated  above  the  adjacent 
skin,  and  in  a  few  days  form  small,  red,  painful  tumors,  which 
seem  inclined  to  suppurate,  and  in  severer  cases  give  a  suspicious 
sense  of  fluctuation,  but  at  last  disappear  without  any  change 
of  structure.  The  first  form  may  last  but  a  few  hours,  or  in 
rare  cases  it  may  continue  two  or  three  weeks ;  the  second  usu- 
sually  continues  for  from  three  to  six  days. 

Before  the  eruption  makes  its  appearance  the  child  is  some- 
times quite  sick,  and  the  febrile  action  is  marked,  and  if  there  is 
a  sudden  retrocession,  we  sometimes  find  the  child  restless  and 
uneasy,  with  nausea,  pain  in  the  head,  and  frequent  pulse. 

Treatment. — Usually  we  put  the  patient  upon  the  use  of 
small  doses  of  Aconite,  with  Belladonna  if  the  eruption  is  not 
out  freely ;  Rhus  if  there  is  frontal  pain,  startings  in  sleep,  and 
red  papillfe  on  tip  of  tongue;  Apis  if  there  is  itching  of  the  sur- 
face ;  Gelseminum  if  the  face  is  flushed  and  the  patient  restless  ; 
Apocynum  if  the  eyelids  are  swollen. 

The  surface  should  be  bathed  with  a  week  solution  of  carbon- 
ate of  potash,  (alkaline  bath,)  and  in  some  cases  we  would  use  the 


ROSEOLA.  451 

warm  foot-bath.  In  the  second  form  of  the  disease,  I  have  usu- 
ally prescribed  a  gentle  laxative,  with  a  solution  of  acetate  of 
potash,  and  very  small  doses  of  Aconite.  The  use  of  the  alkaline 
bath  gives  great  relief,  and  it  may  sometimes  be  repeated  several 
times  a  day.  In  some  rare  cases  there  seems  to  be  a  tendency 
to  excoriation,  and  in  such  cases  I  would  advise  a  lotion  of — 1^ 
Glycerine,  3j.,  Chlorate  of  Potash  gr.  xx.,  rose  water  Sij.; 
mix.  Or  the  part  may  be  dusted  with  powdered  subnitrate  of 
bismuth. 

EOSEOLA. 

Roseola,  or  rose  rash,  is  a  mild  exanthematous  eruption,  con- 
tinuing from  one  to  six  or  seven  days,  and  attended  by  more  or 
less  febrile  action.  The  causes  are  obscure,  though  arrest  of 
secretion  and  gastro-intestinal  irritation,  are  the  most  frequent. 
It  sometimes  occurs  as  an  epidemic,  especially  in  warm  seasons,, 
and  sporadically,  from  over-heating  the  body,  severe  exercise, 
etc.  Four  varieties  have  been  distinguished  :  R.  infantilis,  R. 
cestiva,  R.  autumnalis,  and  R.  annulata. 

Symptoms. — Roseola  infantilis,  as  its  name  indicates,  is  usually 
met  with  in  young  children,  and  arises  form  gastro-intestinal 
irritation,  or  from  dentition.  It  comes  out  in  the  form  of  deep 
rosy-red  patches  about  one-fourth  of  an  inch  in  diameter,  and 
circular  in  form.  When  severe,  they  are  very  much  crowded 
together  so  as  to  give  a  general  red  appearance  to  the  surface, 
but  yet  each  one  is  well  defined.  They  may  continue  for  several 
days,  or  vanish  and  reappear  for  several  days.  Usually  the 
fever  is  but  slight,  but  the  child  shows  symptoms  of  irritation, 
being  cross  and  fretful. 

Roseola  oestiva  is  usually  ushered  in  by  marked  febrile  action, 
and  in  children  delirium  or  convulsions  sometimes  supervene. 
The  eruption  usually  appears  about  the  third  or  fourth  day  on 
the  face  and  neck,  and  in  a  few  hours  involves  the  greater  part 
of  the  body.  ^'The  spots  are  of  a  deep  red  color,  more  irregular 
in  shape  than  those  of  measles,  and  their  original  color  soon 
passes  into  a  light  rosy  hue.  There  is  also  present  a  consider- 
able degree  of  itching  and  pain,  and  often  difficulty  in  swallow- 
ing." The  disease  runs  a  very  variable  course,  but  the  erup- 
tion usually  disappears  in  three  or  four  days  without  desqua- 
mation.    A  bastard  measles,  which  is  contagious,  resembles  this 


452  DISEASES  OF    CHILDREN. 

form  of  roseola.  It  is  known  as  ratheln,  or  German  measles, 
and  as  it  occurs  where  children  have  had  true  measles,  many 
have  supposed  that  persons  could  have  the  disease  twice. 

Roseola  annulata  comes  out  in  the  form  of  rose-red  rings,  in 
the  center  of  which  the  skin  retains  its  natural  color  ;  it  is  said 
to  be  principally  observed  on  the  abdomen  and  buttocks.  It  is 
not  usually  accompanied  with  much  fever,  but  is  occasionally 
very  persistent,  and  is  usually  associated  with  gastro-intestinal 
irritation. 

Diagnosis. — Roseola  may  be  distinguished  from  measles  by 
the  spots  being  larger,  circular,  circumscribed,  and  of  a  deep 
rose  color,  while  the  patches  of  measles  are  small,  irregular,  and 
of  a  common  red  color.  The  eruption  of  scarlet  fever  consists 
of  a  great  number  of  small  red  points  of  a  scarlet  or  raspberry 
color,  and  grouped  together  so  as  to  form  irregular  patches. 

Treatment. — The  patient  has  the  proper  sedative  in  small 
doses,  to  which  may  be  added  such  remedy  influencing  the  skin 
as  may  be  indicated.  If  there  is  dullness  or  inclination  to  sleep. 
Belladonna  is  given  until  the  eruption  comes  freely  to  the  sur- 
face, and  the  nervous  system  is  relieved.  If  the  pulse  is  sharp, 
the  tongue  shows  the  red  papillae,  and  there  is  frontal  pain,  or 
burning  of  the  surface,  Rhus  is  the  remedy.  If  the  itching  is 
severe,  add  Apis  to  the  solution  of  Aconite.  Phytolacca  is  given 
if  there  is  soreness  of  the  mouth  and  throat;  the  carbonate  of 
soda,  if  there  is  a  pallid  tongue;  sulphite  of  soda,  if  the  tongue 
is  broad,  pallid  and  dirty ;  and  sulphurous  acid,  if  the  tongue  is 
red  and  dirty. 

When  there  are  frequent  recurrences  of  roseola,  we  may  sus- 
pect some  wrong  of  the  gastro-intestinal  apparatus,  or  a  failure 
in  waste  and  excretion.  Sulphite  of  soda  and  sulphurous  acid 
are  frequently  indicated  in  these  cases,  and  their  administration 
effects  a  cure.  Lime-water  or  minute  doses  of  sulphite  of  lime, 
will  frequently  prevent  a  recurrence  of  the  attacks.  In  some 
cases  the  patient  will  be  benefited  by  Nux,  in  others  by  arsenic, 
and  in  still  others  by  cod-liver  oil.  Occasionally  tincture  of  mu- 
riate of  iron  in  small  doses  exerts  a  good  influence,  the  disease 
resembling  a  mild  form  of  erysipelas.  In  other  cases  Pulsatilla 
will  prove  a  good  remedy,  and  in  still  others  a  second  trituration 
of  Podophyllin  may  be  given. 


DISEASES  OF  THE  SKIN.  453 

URTICARIA. 

Urticaria,  or  nettle-rash,  occurs  most  frequently  in  childhood, 
though  we  occasionally  see  cases  of  it  in  the  adult.  The  most 
common  cause  is  doubtless  gastro-intestiual  irritation,  though 
the  milder  forms  may  be  caused  by  sudden  changes  of  tempera- 
ture, or  excessive  mental  emotion.  Sometimes  it  is  an  acute 
affection,  but  more  frequently  it  assumes  a  chronic  form,  and  may 
last  for  months  or  years,  reappearing  on  the  slightest  imprudence 
of  diet  or  change  of  habits. 

The  reader  will  know  urticaria  by  its  more  common  name, 
hives,  and  if  he  has  had  much  experience  with  it,  he  will  recall 
many  unpleasant  cases.  It  not  only  varies  in  intensity  and  du- 
ration, but  also  in  the  appearance  of  the  eruption,  in  size,  form, 
and  color;  but  in  all  there  is  the  common  symptoms,  intense 
persistent  itching,  and  sometimes  burning  of  the  skin. 

Symptoms. — Though  divided  into  several  varieties,  it  will  suit 
our  purpose  to  consider  it  as  febrile  and  non-febrile.  In  the  first 
case  the  eruption  is  preceded  for  a  day  or  two  by  slight  febrile 
symptoms,  irritation  of  the  stomach,  and  pain  in  the  epigastrium. 
The  eruption  then  conies  out  in  the  form  of  red  or  pale-red 
blotches,  irregular  in  shape,  elevated  above  the  adjacent  skin, 
hard  around  their  edges,  and  surrounded  by  a  bright  red  or 
scarlet  border.  An  intolerable  pruritus  and  burning  accompany 
the  eruption,  aggravated  by  warmth,  and  usually  by  scratch- 
ing or  rubbing  the  part,  and  is  sometimes  so  severe  as  to  prevent 
the  patient's  sleeping.  The  eruption  is  not  constant,  but  goes 
away  and  re-appears  sometimes  every  few  hours.  The  disease 
usually  continues  for  seven  or  eight  days,  with  some  constitu- 
tional disturbance  during  the  entire  period,  and  at  last  disap- 
pears, leaving  but  slight  itching;  in  severe  cases  there  maybe 
some  desquamation. 

In  some  cases  the  eruption  fails  to  come  out,  and  the  patient 
suffers  from  extreme  nausea,  nervous  irritation  (sometimes  going 
on  to  convulsions),  and  occasionally  marked  febrile  reaction. 
The  swollen  face  and  slightly  mottled  skin,  will  frequently  sug- 
gest hives,  and  we  relieve  the  patient  by  bringing  the  eruj)tion 
to  the  surface.  When  there  is  a  retrocession  of  the  eruption, 
the  patient  is  sometimes  very  sick,  so  that  between  the  intense 
itching  and  burning  when  the  hives  are  out,  and  the  nausea  and 


454  DISEASES   OF  CHILDREN. 

great  prostration  or  febrile  action  when  they  go  iu,  the  patient 
passes  a  very  unpleasant  week.  In  some  cases  marked  croupal 
symptoms  are  observed,  and  this  becomes  an  important  feature. 

The  non-febrile  form  is  usually  chronic,  and  has  been  divided 
into  two  varieties,  U.  evanida  and  U.  tuberosa.  In  the  first,  the 
eruption  appears  at  irregular  intervals  sometimes  for  months  or 
years,  is  not  attended  by  febrile  action,  and  has  not  the  red 
border  just  noticed;  the  spots  look  more  like  those  produced  by 
whipping,  and  are  only  accompanied  by  itching. 

The  last  form  is  very  rare,  and  instead  of  the  slightly  elevated 
blotches,  there  are  broad,  hard,  deep-seated  and  painful  tubero- 
sities which  impede  motion.  It  passes  off  and  reappears  like 
the  preceding  variety,  but  almost  always  leaves  the  patient 
fatigued  and  depressed. 

Diagnosis. — There  is  but  one  disease  {lichen  urticatus)  with 
which  this  can  be  mistaken,  and  from  that  it  may  be  distin- 
guished by  the  large  irregular  blotches,  while  in  litclien,  the 
papulae  are  rounder,  less  prominent,  smaller,  harder,  and  of  a 
deeper  color.  Urticaria  may  be  complicated,  however,  with 
erythema,  roseola,  impetigo  and  litchen. 

Treatment. — In  the  majority  of  cases  the  prescription  will 
be — ^  Aconite  gtt.  iij.  to  gtt.  v.,  Tincture  Belladonna  gtt.  v. ; 
a  teaspoonful  every  hour  until  the  eruption  comes  out  freely  and 
the  patient  is  relieved.  If  now  we  substitute — Ij<  Tincture  Apis 
gtt.  v..  Tincture  Phytolacca  gtt.  x.,  water  .3!  v.,  a  teaspoonful 
every  two  hours  to  relieve  the  itching,  our  patient  will  make  a 
rapid  recovery. 

When  there  is  severe  burning  as  well  as  itching  the  patient 
will  have  Rhus  with  the  Aconite.  In  some  of  these  cases  the 
irritation  of  the  nervous  centers  would  call  for  Rhus  if  there  was 
not  the  prominent  symptom,  "burning  with  itching." 

In  rare  cases,  the  evidences  of  accumulations  in  the  stomach — 
heavily  coated  tongue  and  fullness  in  the  epigestrium — will  de- 
mand an  emetic.  UsuaHy  the  nasty  tongue  and  breath  will  be 
met  with  sulphurous  acid,  or  sulphite  of  soda. 

If  there  is  marked  oppression  of  the  respiratory  apparatus, 
with  cough,  and  increased  secretion  of  mucus,  we  may  use 
Lobelia,  either  with  Veratrum,  in  the  usual  way,  or  as  named 
heretofore.     I^  Tincture  Lobelia  5jv  Comp.  Tincture  Lavender 


ERYSirELAS.  455 

o'lij.,  simple  syrup  Siss.,  Croupal  symptoms  are  best  met  by  an 
application  of  stillingia  liniment  over  the  larynx,  and  sometimes 
its  internal  administration  in  half  drop  or  drop  doses.  If  con- 
vulsions are  threatened  the  patient  should  have  bromide  of 
ammonium. 

When  the  skin  is  feeble,  and  the  eruption  does  not  appear,  the 
patient  may  be  rapidly  sponged  with  hot  waterj  before  a  fire, 
being  careful  to  prevent  chill.  A  hot  foot  bath  (a  full  half  hour 
and  plenty  of  water  lioi)  will  sometimes  give  great  relief.  When 
the  eruption  is  out,  and  the  patient  complains  of  excessive  itch- 
ing, tlie  old-fashioned  alkaline  bath  may  be  employed,  or  a  salt 
water  bath  will  sometimes  give  relief. 

ERYSIPELAS. 

Erysipelas  would  have  been  more  properly  classed  with  febrile 
diseases,  as  in  many  respects  it  resembles  them.  The  constitu- 
tional affection  is  the  primary  disease,  and  of  which  the  local  in- 
flammation is  but  the  outgrowth. 

It  is  not  so  frequently  met  with  in  children  as  in  the  adult, 
but  occasionally  is  quite  a  serious  affection.  Thus  we  will  see  it 
during  the  first  week  of  life  in  erysipelatous  inflammation  about 
the  umbilicus;  at  a  later  period  affecting  the  genitalia  and  nates; 
and  from  two  years  upward  attacking  the  extremities.  It  is  a 
singular  fact  that  children  rarely  have  erysipelas  of  the  face, 
which  is  the  most  common  seat  of  the  disease  in  the  adult. 

Causes. — Erysipelas  undoubtedly  belongs  to  the  class  of 
zymotic  diseases,  in  which  there  is  a  blood-poison.  What  this 
peculiar  poison  is,  Ave  do  not  know,  or  how  it  is  generated, 
farther  than  that  it  seems  to  be  produced  in  certain  depressed 
conditions  of  the  system,  where  there  is  rapid  waste  of  tissue  and 
imperfect  excretion.  When  once  generated,  it  has  the  power  of 
propagating  itself,  and  at  times  will  become  eminently  con- 
tagious. 

Pathology. — As  above  remarked,  the  disease  is  undoubtedly- 
produced  by  a  blood  poison,  and  the  first  lesion  is  of  the  fluids, 
manifested  by  the  usual  symptoms  of  fever.  Following  this,  we 
have  an  inflammation  of  the  skin,  and  occasionally  of  the  deeper 
tissues.  The  inflammation  does  not  at  first  seem  to  differ  from 
that  produced  by  other  causes,  further  than  that  the  circulation 


■45S  DISEASES   OE  CHILDilEN. 

is  more  impaired.  But  as  'it  advances  the  tissues  seem  to  lose 
vitality,  and  the  exudation  is  of  a  depraved  serum  rather  than 
coagulable  lymph. 

Symptoms. — The  symptoms  vary  in  different  cases,  not  only 
in  intensity,  but  in  their  order.  Usually,  the  child  seems  de- 
pressed for  a  day  or  two,  the  appetite  being  impaired,  the  breath 
bad,  and  the  sleep  broken.  Following  this  there  is  febrile 
action,  frequently  coming  up  slowly,  but  sometimes  rising 
quickly  and  running  an  active  course. 

With  the  appearance  of  the  fever  the  cutaneous  disease  shows 
itself,  usually  in  the  form  of  a  red  spot,  where  the  skin  is  evi- 
dently swollen,  hot  and  painful.  As  the  disease  progresses,  we 
find  the  redness  extending,  with  the  same  induration  of  the  skin, 
and  other  evidences  of  inflammation. 

Occasionally  in  the  course  of  two  or  three  days  the  epidermis 
is  loosened  and  distended  with  a  yellowish  serum,  forming 
bullae  of  larger  or  smaller  size,  and  these  rupturing  pour  out 
their  secretion,  and  sometimes  become  covered  with  thin  in- 
crustations. The  redness  usually  fades,  and  tlie  inflammation 
commences  to  disappear  by  the  fifth  or  sixth  day,  leaving  the 
epidermis  wrinkled  and  yellowish,  and  at  last  it  desquamates 
over  the  entire  surface. 

The  fever  is  in  some  degree  dependent  upon  the  local  lesion. 
When  this  is  acute  it  runs  a  very  active  course,  and  gradually 
subsides  as  the  inflammation  passes  off.  In  other  cases  the  fever 
is  of  an  asthenic  type,  and  sometimes  presents  marked  typhoid 
symptoms. 

We  observe  another  form  of  the  disease  in  children  of  from 
six  to  twelve  years.  They  complain  of  soreness  of  the  legs  and 
feet  and  lameness,  and  when  examined  the  parts  are  slightly 
swollen,  the  skin  smooth  and  glistening,  and  presenting  a 
peculiar  mottled  red  and  purplish  discoloration.  The  child's 
health  has  not  been  good  for  some  days;  its  appetite  is  im- 
paired, its  bowels  irregular,  breath  bad,  and  it  is  evidently  losing 
flesh. 

Diagnosis. — The  peculiar  redness  of  the  skin,  with  swelling, 
and  the  burning  heat  that  attends  it,  are  characteristic.  Associa- 
ted with  this  is  the  marked  constitutional  disturbance,  rendering 
the  diagnosis  certain. 


ERYSIPELAS.  4o7 

Prognosis. — Usually  we  will  have  but  little  difficulty  in  con- 
trolling the  local  and  general  disease,  and  remedies  will  give 
much  satisfaction.  Some  eases  will  be  quite  intractable,  but 
upon  the  whole  the  mortality  will  be  but  small. 

Treatment. — The  treatment  of  erysipelas  illustrates  the  truth 
of  specific  medication,  both  as  regards  the  action  of  the  small 
dose,  and  the  advantage  of  following  special  indications  for  the 
selection  of  the  remedy.  If  the  reader  will  consult  the  article 
"Anti-erysipelatous  Remedies,"  in  the  first  part  of  this  work,  he 
will  be  able  to  see  this  better.  The  remedies  in  common  use  are 
Veratrura,  Rhus,  Tinct.  Muriate  of  Iron  and  Sulphite  of  Soda. 

Veratrum  is  indicated  by  a  full  pulse,  and  the  ordinary  red- 
ness of  inflammation,  all  the  inflammatory  symptoms  being 
marked.  It  is  given  internally  in  the  proportion  of — R  Tinct. 
Veratrum  gtt.  v.,  water  o'v.,  a  teaspoonfnl  every  hour,  and  ap- 
plied locally  of  full  strength,  to  one  part  to  ten  of  water,  or 
water  and  glycerine. 

Rhus  is  indicated  by  the  brighter  redness,  burning  pain,  vesi- 
cation, sharp  pulse,  and  irritation  of  the  nerve  centers.  We 
prescribe  it  as  follows — ^  Tinct.  Rhus  gtt.  iij.  to  gtt.  v.,  Tinct. 
Aconite  gtt.  iij.,  water  .^iv.,  a  teaspoonfnl  every  hour.  When 
indicated  its  action  is  very  prompt  and  decided. 

Tincture  of  muriate  of  iron  is  given  in  small  doses,  where  the 
mucous  membranes  are  red,  either  dusky  or  livid.  The  remedy 
is  best  given  with  glycerine  as  heretofore  named.  This  is  also 
the  remedy  for  the  last  form  named,  and  its  continuance  for  a 
few  days  will  entirely  remove  the  unpleasant  symptoms,  without 
local  applications. 

Where  the  tongue  is  pallid,  broad,  and  covered  with  a  pasty 
white  coat,  sometimes  pitting  where  it  comes  in  contact  with  the 
teeth,  sulphite  of  soda  is  the  remedy.  To  a  child  two  years  old 
it  may  be  administered  in  doses  of  three  to  five  grains  every  two 
hours. 

In  young  children  the  best  local  application  is  soft  cloths 
spread  with  fresh  lard.  In  other  cases  we  will  find  an  excellent 
remedy  in  one  part  of  the  tincture  of  muriate  of  iron  to  five 
parts  of  glycerine.  AVhen  the  erysipelatous  inflammation  is 
deep  seated,  and  likely  to  progress  to  sloughing,  a  solution  of 
Permanganate  of  Potash,  5j-,  to  water,  Oj.,  used  as  a  wet  dress- 
ing, will  be  found  an  admirable  remedy. 


458  DISEASES   OF    CHILDREX. 

ORDER    II.— VESICUL^. 

The  distinguishing  characteristic  of  this  order  is,  tl»e  forma- 
tion of  small  vesicles  by  au  elevation  of  the  epidermis,  which  are 
filled  with  a  serous  fluid.  This  fluid,  at  first  transparent,  in 
severe  cases  becomes  yellowish  and  opaque,  and  is  finally  either 
absorbed,  or  dries  and  forms  scales  or  incrustations.  The  vesicle 
is  always  round,  and  may  or  may  not  stand  upon  an  inflamed 
base.  One  variety  of  this  order,  varicella,  has  already  been  de- 
scribed with  the  eruptive  fevers, 

MILARIA. 

Milaria,  or  sudamina,  most  generally  appears  as  an  attendant 
upon  other  diseases,  more  especially  typhoid,  and  the  advanced 
stages  of  other  fevers  and  inflammations.  There  are  exceptional 
cases  in  "which  it  assumes  an  idiopathic  form,  as  for  example, 
when  it  appears  in  healthy  subjects  after  violent  exercise  in  warm 
weather;  in  these  instances  it  is  generally  accompanied  with 
copious  perspiration.  The  eruption  is  then  attended  with  a  dis- 
agreeable sensation  of  heat  and  itching.  The  number  of  vesi- 
cles is  sometimes  very  considerable,  but  they  are  ephemeral,  and 
disappear  in  the  course  of  twenty-four  hours." — (Cazeuave.) 
The  miliary  vesicle  is  small,  not  larger  than  a  pin's  head,  and 
the  contents  being  clear  and  transparent,  it  can  not  be  seen  well 
unless  we  look  across  the  surface.  They  are  usually  grouped 
together  in  patches,  upon  the  thorax  and  neck,  and  in  rare  cases 
become  confluent,  forming  bullae.  They  demand  no  treatment, 
being  simply  symptomatic  of  other  diseases. 

ECZEMA. 

Eczema,  humid  tetter,  or  running  scall,  is  characterized  by  an 
eruption  of  small  vesicles  grouped  and  crowded  together,  and 
forming  more  or  less  well  defined  patches.  It  may  be  divided 
into  the  acute  and  chronic  form,  and  these  have  to  be  still  fur- 
ther divided  into  several  varieties.  The  causes  of  eczema  are 
very  obscure,  and  it  is  non-contagious,  except  in  rare  cases  where 
the  disease  affects  the  genital  organs. 

Symptoms. — Eczema  inJantiUs  is  the  milk-scall  that  is  some- 
times found  so  troublesome  during  the  first  year,  and  occasionally 


ECZEMA.  459 

continuing  after  this.  It  makes  its  appearance  in  the  form  of 
transparent  vesicles  about  the  ears,  sometimes  upon  the  face. 
These  increase  in  number,  gradually  extending  from  part  to 
part,  until  a  large  surface  is  diseased.  The  vesicle  continues  but 
a  day  or  two,  then  rupturing,  a  crust  is  formed,  beneath  which 
pus  in  found,  and  the  crust  is  renewed  as  often  as  detached. 
Thus  running  together,  large  surfaces  are  covered  with  single 
crusts,  from  which  there  is  an  offensive  discharge. 

In  many  cases  the  disease  manifests  but  little  tendency  to 
recovery,  sometimes  continuing  for  months. 

Eczema  simplex  commences  with  a  sensation  of  itching,  which 
is  soon  followed  by  the  appearance  of  numerous  small  trans- 
parent vesicles,  flattened,  and  set  close  together ;  after  a  time  the 
fluid  they  contain  becomes  opaque,  and  they  finally  rupture, 
forming  a  small  thin  scab  which  is  soon  detached.  They  appear 
more  frequently  upon  the  fore-arm,  and  where  the  skin  is  thin 
and  delicate,  and  frequently  between  the  fingers,  somewhat  re- 
sembling the  itch. 

Eczema  rubrum  is  accompanied  with  considerable  heat  and 
tension  of  the  skin,  and  at  first  the  vesicles  nuiy  be  observed  as 
small  solid  points,  but  they  soon  become  true  vesicles,  which 
attain  the  size  of  a  pin's  head,  and  finally  disappear  about  the  sixth 
or  eighth  day.  In  some  cases  the  vesicles  coalesce  and  rupture,  a 
disagreeable  excoriation  producing  repeated  incrustations  being 
left. 

In  eczema  impeilgnodes  the  inflammation  of  the  skin  is  very 
marked  and  it  is  swollen,  the  vesicles  are  larger,  and  the  con- 
tained fluid  loses  its  transparency  and  becomes  purulent,  and 
fiiuilly  they  rupture,  forming  a  scab,  which  is  thrown  ofl'and  re- 
formed sometimes  for  two  or  three  weeks.  Acute  eczema  of  the 
two  la^  forms  is  usually  attended  with  well  marked  febrile 
action,  which  continues  for  two  or  three  days,  and  sometimes 
for  a  longer  period.  The  eruption  is  always  accompanied  by 
itching,  which  is  sometimes  very  severe  and  troublesome. 

Chronic  eczema  most  generally  results  from  an  acute  attack, 
and  may  continue  for  months,  or  even  years.  In  these  cases  the 
skin  becomes  deeply  inflamed  and  excoriated,  and  fissures  fi)rm 
about  the  joints;  a  continuous  ichorous  discharge  is  kept  uj), 
which  increases  the  irritation,  and  forms  thin  crusts,  or  coming 
in  contact  with  the  clothing  agglutinates  it  to  the  part,  and  when 
removed  there  is  much  pain  and  smarting,  and  sometimes  a  con- 


460  DISEASES   OF   CHILDREX. 

sitlerable  flow  of  blood.  When  the  crusts  are  detached,  tlie  sur- 
face is  found  reddened,  soft,  and  swollen.  In  other  cases  there 
is  less  exudation,  the  skin  being  dry,  inflamed,  and  fissured,  and 
covered  by  slight  crusts.  "Chronic  eczema  is  invariably  attended 
with  intense  itching,  more  distressing  than  the  severest  pain. 
The  patient  in  vain  struggles  against  it,  but  he  can  not,  however, 
resist  the  urgent  desire  to  scratch  himself,  and  thus  increases  liis 
suffering.  After  a  certain  period  the  itching  begins  to  subside, 
the  serous  exudation  gradually  ceases,  the  scaly  incrustations  dry 
up,  and  the  skin  is  less  inflamed.  Finally,  the  disease  becomes 
reduced  to  a  small,  dry,  red  surface,  wliich  is  covered  with  ex- 
tremely thin,  laminated  crusts.  The  surrounding  skin  *is  smooth, 
tense,  and  firm,  and  only  slowly  resumes  its  natural  state." 
(Cazenave.) 

Diagnosis. — It  may  be  distinguished  from  itch  by  the  flatness 
of  the  vesicles,  and  their  being  grouped  together,  while  in  itch, 
they  are  pointed  and  isolated.  The  diagnosis  of  chronic  eczema 
from  lichen  is  sometimes  difficult,  but  usually  the  presence  of 
papulae  near  the  red  inflamed  surface  is  sufficient. 

Treatment. — In  acute  eczema,  if  there  is  some  febrile  action, 
we  prescribe  Aconite  with  Rhus;  or  if  there  is  no  frequency  of 
pulse  or  increase  of  temperature,  Rhus  with  Phytolacca.  Rhus 
exerts  a  specific  influence  upon  the  skin,  and  if  there  is  no  indi- 
cation for  other  remedies,  it  will  serve  a  good  purpose  in  all  these 
cases.  In  some  it  can  be  given  in  full  doses,  but  in  many  it  must 
be  used  in  small  doses,  for  in  the  usual  quantity  it  increases  the 
eruption.  Phytolacca  is  especially  a  good  remedy  when  there  is 
fulhiess  of  the  lymphatic  glands. 

If  I  M'cre  called  upon  to  select  a  specific  remedy  for  eczema,  I 
§hould  take  sulpliite  of  soda,  especially  in  the  chronic  form.  In 
nianv  cases  the  indications  for  it  will  be  found  at  first,  in  the 
nioderatoly  full  and  jiallid  tongue,  dirty.  In  other  cases  sulphu- 
rous acid  will  be  the  remedy,  in  doses  of  gtt.  x.  to  5ss.  three  or 
four  times  a  day. 

In  chronic  oozoma  with  a  pallid  and  atonic  skin.  Fowler's  So- 
lution irtt.  X.,  Tinct.  Phytolacca  gtt.  x.,  water  .^iv.,  a  teaspoonful 
four  times  a  day,  will  prove  beneficial.  In  rare  cases  Donovan's 
Solution  may  be  substituted  for  Fowler's. 

Cod-liver  oil,  the  compound  syrup  of  the  hypophospliitos, 
lime-water,  hypophosphite  of  lime,  and  occasionally  some  of  the 


HERPES.  461 

vegetable  alteratives,  especially  the  Alnus,  Rumex,  and  Seroph- 
ulaiia,  will  come  in  place.  Sulphur  in  the  old-fashioned  dose 
may  sometimes  be  used,  if  the  disease  is  very  persistent. 

In  milk-scall  I  have  obtained  marked  advantage  from  the  use 
of  an  ointment  from  the  inner  bark  of  the  common  elder  (Sam- 
bncus).  Occasionally  a  glycerole  of  starch  answers  the  ])urpo.sc 
well,  or  a  small  portion  of  oxide  of  zinc  may  be  added  to  it.  In 
very  severe  cases  of  chronic  eczema,  I  employ  brown  citrine 
ointment  one  part  with  two  parts  of  simple  cerate.  It  is  to  be 
employed  carefully,  and  not  on  too  large  a  surface  at  once.  In 
other  cases  an  infusion  of  Alnus,  Rumex  and  Quercus  Rubra,  is 
an  excellent  local  application. 

In  some  cases  a  general  bath,  rendered  emollient  by  the  addi- 
tion of  mucilage  or  gelatin,  will  be  beneficial;  it  should  be  about 
ninety  degrees  Fahrenheit,  and  continued  for  an  hour  or  longer. 
In  place  of  this  we  may  use  the  vapor  bath,  repeating  it  two  or 
three  times  weekly. 

HERPES. 

Herpes  is  most  generally  an  acute  disease,  and  is  characterized 
by  an  eruption  of  vesicles  grouped  together  on  an  inflamed  base. 
The  causes  are  unknown.  Five  varieties  are  distinguished  :  H, 
j)hlyctenoides,  H.  labialis,  H.  prseputialis,  H.  zoster,  and  H. 
circinatus. 

Symptoms. — Herpes  "phlydenoides  is  usually  attended  by  slight 
indisposition,  loss  of  appetite,  and  constipation.  The  patient 
feels  a  smarting,  burning  sensation  of  some  part,  and  upon 
examination  finds  a  number  of  slightly  red  spots,  upon  which  in 
a  short  time  is  developed  six  or  eight  firm  and  prominent  vesi- 
cles from  the  size  of  a  millet  seed  to  that  of  a  small  pea.  At 
first  they  are  transparent,  but  in  the  course  of  a  day  become 
opaque  and  milky ;  there  is  frequently  a  sensation  of  itching, 
and  sometimes  the  part  feels  quite  painful.  They  commence  to 
decline  about  the  fourth  or  fifth  day,  drying  up  and  leaving 
larger  or  smaller  incrustations,  and  by  the  eighth  or  tenth  day 
they  have  entirely  disappeared,  nothing  but  redness  of  the  sur- 
face remaining. 

Herpes  labialis  is  usually  preceded  by  slight  indisposition  and 
fever,  and  hence  the  vesicles  are  often  termed  fever  blisters.  It 
usually  comes  out  at  the  junction  of  the  skin  and  mucous  mem- 


462  DISEASES   OF   CHILDREN. 

brane,  but  may  appear  ia  the  mouth,  or  as  fur  back  as  the 
pharynx.  It  is  usually  preceded  for  a  few  hours  by  redness, 
and  sometimes  the  part  is  swollen  and  painful.  The  vesicles  are 
of  various  sizes,  the  largest  about  the  size  of  a  small  pea ;  at  first 
they  are  transparent,  but  in  two  or  three  days  become  opaque 
arid  yellow,  and  in  two  or  three  days  more  desiccate,  forming 
brownish  crusts. 

Herpes  prcepuiialis  appears  on  the  external  surface  of  the 
prepuce,  small  inflamed  spots  being  first  noticed,  which,  in  the 
course  of  a  few  hours,  are  covered  with  groups  of  small  globose 
vesicles.  It  runs  a  similar  course  to  that  just  noticed,  but  in 
some  cases  continues  to  reappear  for  years,  causing  great  annoy- 
ance to  the  patient. 

Herpes  zoster,  or  shingles,  is  usually  the  severest  form  of  the 
disease,  being  attended  in  many  cases  with  marked  febrile  action. 
It  usually  makes  its  appearance  on  the  trunk  in  irregular 
patches  of  a  red-color,  which  are  soon  covered  with  vesicles;  new 
patches  coming  up,  the  disease  may  pass  entirely  round  the  body, 
though  Cazenave  states  that  it  never  appears  but  upon  one  side 
at  a  time.  The  vesicles  resemble  those  already  described,  but 
are  sometimes  larger;  they  usually  disappear  in  four  or  five  days, 
leaving  at  some  points  thin,  brown  incrustations,  which  are  soon 
detached.  The  disease  usually  lasts  for  ten  or  fourteen  days, 
and  sometimes  longer. 

Herpes  cireinatus,  or  ringworm,  appears  most  frequently  upon 
the  face,  neck  and  arms,  though  it  may  come  out  on  any  portion 
of  the  body.  It  comes  out  at  first  as  a  red  spot  about  the  size 
of  a  dime  on  which  shortly  appear  numerous  small  vesicles  ar- 
ranged in  rings,  hence  the  common  name  of  ringworm;  it  is  not 
attended  with  constitutional  disturbance,  and  generally  disap- 
pears in  ten  or  twelve  days. 

Diagnosis. — The  diagnosis  of  herpes  is  generally  easy,  the 
vesicles  being  round,  prominent,  and  grouped  together  on  one 
inflamed  or  red  base;  the  symptoms  of  the  different  forms  are 
usually  sufficiently  marked  for  their  easy  distinction,  as  above 
described. 

It  is  generally  thought  that  but  little  if  any  treatment  is  re- 
quired in  herpes,  but  many  times  this  is  a  mistake,  for  the  erup- 
tion is  but  a  symption  of  a  deeper  disease,  and  if  not  looked  after 
it  may  leave  permanent  impairment  of  the  health.     In  the  first 


DISEASES  OF  THE  SKIN.  463 

fv)riu  of  the  disease,  the  patient  may  have  the  usual  closes  of 
Aconite  with  Rhus,  or  Phytolacca,  until  the  eruption  has  ceased 
and  the  crusts  are  thrown  oif.  Sometimes  a  day's  treatment  will 
thus  remove  the  disease  when  otherwise  it  might  have  lasted  fur 
ten  days. 

Tiie  same  treatment  may  be  adopted  for  herpes  labialis,  or 
Aconite  with  Phytolacca.  But  occasionally  in  both  these  forms 
there  will  be  indications  for  sulphurous  acid  or  sulphite  of  soda, 
and  the  general  health  will  be  much  improved  by  their  use. 
Herpes  labialis  is  sometimes  an  unpleasant  symptom.  If  per- 
sistent and  associated  with  some  pain  in  the  chest,  and  slight 
cough,  it  indicates  disturbance  of  all  the  vegetative  functions, 
and  eventually  tuberculosis.  Treatment  cannot  be  commenced 
too  early  in  such  cases,  and  the  patient  should  be  carefully 
watched  for  some  time. 

Herpes  pr£Eputialis  is  frequently  cured  with  soap  and  water, 
a  good  castile  soap,  or  Colgate's  glycerine  soap ;  sometimes  we 
order  a  lotion  of  borax  and  rose  water,  salicylic  acid  with 
borax,  or  in  some  cases  the  application  of  the  citrine  ointment. 

Shingles  is  treated  with  the  special  sedatives  and  such  addi- 
tional remedies  as  may  be  indicated.  If  there  is  nausea  and 
prostration  from  uon  appearance  or  retrocession  of  the  eruption 
Ave  add  Belladonna ;  if  there  is  severe  burning  of  the  surface 
with  nervous  disturbance  it  is  Rhus;  with  intense  puritus  Apis; 
with  pallid  tongue  and  soreness  of  the  mouth  and  throat  it  will 
be  Phytolacca  ;  when  the  tongue  is  pallid  and  dirty,  sulphite  of 
soda  is  given;  when  it  is  red  and  dirty  sulphurous  acid. 

Herpes  circinatus  is  usually  cured  by  the  local  application  of 
a  saturated  solution  of  iodide  of  ammonium,  or  sulphurous 
acid.  In  some  very  persistent  cases  we  will  find  internal 
remedies  needed,  and  sulphurous  acid,  sulphite  of  soda,  minute 
doses  of  arsenic,  and  cod  liver  oil  may  be  suggested,  as  indi- 
cated. 

SCABIES. 

Scabies,  or  itch,  though  a  vesicular  disease,  is  produced  by  an 
animal  parasite — the  acarus  scabiei — and  hence,  as  this  insect 
possesses  a  very  tenacious  vitality,  the  disease  is  rendered  con- 
tagious by  its  transmission  from  one  to  another.  The  acarus  is 
usually  found  a  short  distance  from  the  vesicle,  in  a  small  fur- 
row leading  from  it.     With  good  sight  or  a  magnifying  glass,  it 


464  DISEASES   OF  CHILDREN. 

can  be  seen  as  a  small,  round,  grayish  body,  sometimes  moviwor, 
sometimes  at  rest.  Under  the  microscope,  its  body  is  seen  to  be 
oval,  the  back  convex,  and  marked  with  curved  lines,  its  head 
covered  with  fine  hairs,  and  eight  legs  passing  from  its  abdomen. 
The  insect  passes  from  one  part  to  another,  by  burrowing  under 
the  epidermis,  but  is  only  conveyed  to  distant  parts  by  the 
fingers,  after  scratching,  and  by  the  clothing. 

Symptoms. — Scabies  almost  always  makes  its  first  appearance 
between  the  fingers  and  front  part  of  the  wrist,  in  the  form  of 
small  pointed  vesicles,  containing  a  clear,  limpid  fluid,  and  a 
a  very  fine  line  leading  from  it,  and  marking  the  situation  of 
the  acarus.  An  intense  but  pleasurable  sensation  of  itching 
attends  their  appearance,  and  the  patient  can  not  resist  the  incli- 
nation to  scratch  or  rub  the  part,  though  this  sometimes  gives 
rise  to  a  sensation  of  smarting  if  too  severe.  As  the  disease 
progresses,  the  irritation  of  the  skin  by  the  nails  usually  pro- 
duces suppuration  in  the  vesicles,  the  result  being  the  formation 
of  larger  or  smaller  scabs,  and  some  inflammation  and  stiff'ness 
of  the  skin.  In  severe  cases  we  occasionally  see  in  the  inter- 
space between  the  fingers  a  large  festering  surface  covered  with 
thick  scabs,  and  the  hands  so  stiff  and  painful  that  they  can 
hardly  be  used.  Sometimes  the  itcli  is  confined  to  the  hands, 
but  in  others  it  is  conveyed  to  the  flexures  of  the  joints,  to  the 
perineum,  around  the  anus,  and  in  fact  wherever  the  skin  is  thin 
and  delicate.  In  all  these  situations  we  may  have  the  suppu- 
rative action  above  named,  so  that  occasionally  instead  of  a  mild 
vesicular  disease,  the  patient  will  be  covered  with  foul,  painful, 
ulcerating  sores. 

Itch  never  terminates  spontaneously,  but  may  last  for  years. 
In  some  cases  it  never  passes  the  vesicular  form  first  named,  but 
in  a  majority,  especially  where  cleanliness  is  neglected,  it  goes 
on  to  the  formation  of  hard  scales,  and  induration  of  the  skin. 

Diagnosis. — The  diagnosis  of  itch  is  generally  not  difficult, 
as  tlie  vesicles  are  pointed  and  solitary,  while  in  eczema  they  are 
flattened,  and  in  prurigo  tlie  eruption  is  first  papular,  as  it  is 
also  in  lltclien,  and  in  neither  case  does  it  appear  between  the 
fingers,  the  frequent  scat  of  scabies.  The  sulcus  passing  from 
the  visicle  in  itch  is  a  good  diagnostic  feature,  though  not  usu- 
ally very  well  marked.     In   the   severer  stages  of  the  disease, 


SCABIES.  465 

there  would  be  difficulty  in  the  diagnosis  were  it  not  for  the 
constant  reappearance  of  the  disease  in  its  original  form. 

Treatment. — The  object  of  treatment  is  to  destroy  the  itch 
insect,  and  whatever  will  accomplish  this  with  the  greatest  cer- 
tainty, and  in  the  least  time,  will  prove  the  best  remedy.  Sul- 
phur has  formed  the  basis  of  most  applications,  and  is  I  believe 
the  best  remedy.  We  may  use  it  in  the  form  of  ointment  mixed 
with  lard,  or  with  an  alkali,  as — I^  Sulphur  Sub.  5ij.,  Subcar- 
bonate  of  Potash  5j.,  Lard  .5viij  ;  mix.  Or,  I^  Prepared  Chalk 
§iv.,  Sulphur,  Tar,  aa.  5vj.,  Soft  Soap,  Lard,  aa.  §xvj.;  mix. 
These  ointments  should  be  thoroughly  applied  to  the  parts 
affected.  It  is  hardly  sufficient  to  say,  cleansed  with  soap  and 
water,  for  it  requires  a  thorough  saturation  of  the  affected  part 
with  soap,  and  then  its  removal  with  soft  warm  water  (soft  soap 
is  best).  The  parts  should  be  thoroughly  dried  before  the  oint- 
ment is  applied,  and  it  may  be  toasted  in  before  a  fire.  If  now 
the  patient's  clothing  is  entirely  changed,  and  the  old  clothes 
boiled,  we  may  expect  an  immediate  cure;  if  not  the  process 
should  be  repeated. 

I  have  used  a  combination  of — I^  Sulphuret  of  Potassium,  5ss., 
Oils  of  Rosemary  and  Lavender,  aa.  oj-,  Lard  5vj.,  mix,  and 
apply  as  before.  Cazenave  states  that  after  repeated  trials  they 
determined  that  the  two  following  formulae  yielded  the  most 
satisfactory  results — ^  Essence  of  Peppermint,  Rosemary, 
Lavender  and  Lemon,  aa.  gtt.  iv.  to  gtt.  vj..  Alcohol,  5jss., 
weak  infusion  of  Thyme,  Ovj.;  it  was  freely  used,  and  the  cure 
resulted  in  eight  days.  ^  Iodide  of  Sulphur,  Iodide  of  Potas- 
sium, aa.  3jss.,  water  Oij.;  the  mean  duration  being  six  days. 
They  say,  whatever  the  lotion  employed,  it  is  necessary  not  only 
to  wet  the  affected  parts,  but  to  prolong  its  application,  so  as  to 
produce  that  kind  of  maceration  which  is  required  to  destroy  the 
insect.  A  solution  of  sulphuret  of  lime,  5ij.  to  the  pint  of 
water  is-  very  efficient,  the  cure  being  effected  sometimes  with 
three  or  four  applications. 

In  the  milder  forms  of  the  diseases  no  internal  treatment  is 
necessary,  but  the  patient  should  be  guarded  against  cold,  damp- 
ness, and  sudden  changes  of  temperature,  and  change  his  entire 
under-clothing  every  day.  In  the  more  persistent  cases,  we 
may  give  equal  parts  of  sulphur  and  cream  of  tartar,  to  the  ex- 
tent of  keeping  the  bowels  open,  and  in  some  cases  where  the 
30 


466  DISEASES  OF   CHILDREN. 

patieut  is  cachectic,  the  bitter  tonics  and  iron.  T  have  cured  the 
itch  with  a  local  application  of  the  Phytolacca  and  Podophyllum, 
but  I  prefer  the  remedies  first  named. 

ORDER    III.— BULL^, 

This  order,  it  will  be* recollected,  is  characterized  by  the  form- 
ation of  large  hlebs,  or  blisters,  from  the  size  of  a  pea  to  a  hen's 
egg,  sometimes  with  and  sometimes  without  redness  of  the  skin. 
Properly  speaking,  there  is  but  one  variety,  liemphigus,  but  some 
authors  class  rupia  under  this  order.  Both  affections  are  usually 
chronic,  and  may  appear  in  succession,  on  any  part  of  the  body. 

We  have  no  knowledge  of  their  causes  further  than  they  are 
usually  associated  with  a  cachectic  condition  of  the  system. 

PEMPHIGUS. 

Pemphigus  is  almost  always  associated  with  general  debility, 
and  imperfect  performance  of  the  various  functions  of  digestion, 
assimilation  and  secretion,  though  the  person  may  seem  to  enjoy 
tolerably  good  health.  It  makes  its  appearance  in  the  form  of 
blebs,  or  blisters,  from  the  size  of  a  split  pea  to  an  inch  or  more 
ill  diameter,  containing  a  thin  transparent  serum.  They  fre- 
quently increase  in  size  for  two  or  three  days,  the  fluid  becoming 
straw-colored  when  they  are  ruptured,  and  a  thin  brownish  crust 
forms.  Sometimes  the  surface  heals  at  once,  but  at  others  these 
crusts  are  reproduced  for  several  days  or  even  weeks. 

Diagnosis. — The  diagnosis  is  always  easy  when  they  first  ap- 
pear, as  in  no  other  skin  disease  do  we  see  such  a  large  elevation 
of  the  epidermis.  When  they  have  ruptured  the  diagnosis  is 
more  difficult,  but  it  may  usually  be  distinguished  from  other 
affections  by  the  brown  thin  scab,  and  by  the  dark-red  irregular 
spot  when  it  is  removed. 

Treatment. — In  the  milder  form  of  the  disease,  Tinct.  Rhus 
gtt.  v.,  Tinot.  Phytolacca  gtt.  x.,  water  5iv.,  in  teaspoonful  doses 
every  two  or  three  hours,  will  be  sufficient  to  effect  a  cure.  In 
cases  where  the  face  is  full  and  purplish,  Baptisia  may  replace 
the  Rhus. 

If  the  tongue  is  pallid  and  dirty,  give  sulphite  of  soda,  grs.  ij. 
to  grs.  V.  every  two  hours;  if  red   and   dirty,  sulpluirous  acid 


EUPiA.  .  467 

■will  be  the  remedy.  If  the  disease  persists,  we  may  prescribe 
1^  Fowler's  Solution  gtt.  x.,  Tinct.  Phytolacca,  gtt.  x.,  water 
5iv. ;  a  teaspoonful  every  four  hours.  lu  some  cases  cod-liver 
oil  will  be  of  service ;  iu  others  the  hypophosphite  of  lime,  com- 
pound syrup  of  the  hypophosphites,  or  some  preparation  of  malt 
after  meals  to  aid  digestion. 

If  the  bullffi  are  large,  and  the  surface  painful  when  they  rup- 
ture, it  may  be  dressed  with  equal  parts  of  lime-water  and  linseed 
oil,  or  powdered  elm,  flour  or  hydrastis  may  be  sprinkled  on  it 
to  absorb  the  discharges. 

RUPIA. 

This,  like  the  preceding  disease,  is  almost  always  associated 
with  a  cachectic  condition  of  the  system,  and  enfeebled  vitality, 
a.'id  appears  most  frequently  among  the  poor,  destitute,  and  ill- 
fed,  though  occasionally  when  the  patients  have  all  the  comforts 
and  luxuries  of  life.  Its  only  relation  to  the  preceding  disease, 
or  to  this  order,  is  in  its  first  appearance,  and  it  soon  loses  this 
resemblance.  It  is  always  a  chronic  affection,  lasting  from  two 
or  three  weeks  to  many  months.  Three  varieties  are  distin- 
guished :  R.  simplex,  R.  prominens,  and  R.  escharotica. 

Symptoms. — Rupia  simplex  appears  iu  the  form  of  bullae, 
about  the  size  of  a  dime,  round  and  flattened,  and  without  evi- 
dence of  inflammation.  The  contained  fluid  is  at  first  a  limpid 
serum,  but  it  soon  becomes  opaque  and  purulent,  and  finally 
co4icretes,  forming  thick  flat  crusts,  of  a  brownish  color.  These 
fall  off  in  a  few  days,  leaving  a  superficial  ulcer  of  the  skin, 
which  soon  cicatrizes,  but  a  livid-red  color  remains  for  some 
time  afterward. 

Rupia  prominens  makes  its  appearance  in  a  smilar  manner, 
but  the  bullae  are  frequently  larger,  and  the  ulceration  deeper, 
and  the  scales  thicker.  Usually  the  skin  is  reddened,  and  some- 
times there  is  a  burning  sensation  and  pain.  The  scab  seems  to 
grow,  in  many  cases,  by  continued  additions  at  the  base,  and 
becomes  one-fourth  or  even  half  an  inch  in  thickness,  and  coni- 
cal, and  resembles  to  some  extent  a  snail's  shell.  When  the 
scab  is  removed,  a  new  one  frequently  takes  its  place,  and  they 
may  be  thus  reformed  for  months.  In  some  cases  the  ulcer  is 
healed  with  difficulty,  the  edges  being  livid  and  tumefied,  the 
center  pale,  and  bleeding  on  slight  pressure. 


468  •  DISEASES  OF  CHILDEEN. 

Rupia  escharotica  occurs  most  frequently  in  children  up  to 
two  years  of  age.  It  commences  with  the  appearance  of  slightly 
prominent  livid  patches,  upon  which  irregular  and  flattened 
bullae  are  soon  formed  ;  when  the  bullae  break,  ulcerated  surfaces 
are  left  which  secrete  a  disagreeable  unhealthy  pus.  "The  infant 
suifers  from  acute  pain,  and  much  fever  and  insomnolency. 
When  the  disease  assumes  an  intense  form,  death  may  ensue  in 
one  or  two  weeks.  When  it  does  terminate  favorably,  the  ulcer- 
ations are  very  long  in  healing."     (Cazenave.) 

Diagnosis. — Rupia  is  diagnosed  with  ease,  in  most  cases,  by 
the  prominent,  conical,  brown  scabs,  those  of  pemphigus  being 
flat.  Ecthyma  resembles  it  most  in  some  cases,  and  it  will  be 
difficult  to  distinguish  between  them  in  its  later  stages,  but  the 
hard  and  inflamed  base,  irregular  scabs,  and  superficial  excoria- 
tions, are  usually  sufficiently  diagnostic. 

Treatment. — The  treatment  in  this  disease,  as  in  the  pre- 
ceding, should  be  strictly  tonic,  arrest  of  the  skin  disease  depend- 
ing to  a  great  extent  upon  the  restoration  of  the  general  health. 
I  have  obtained  the  best  results  from  the  administration  of 
Fowler's  Solution  of  Arsenic  with  Phytolacca  as  heretofore 
named.  Cases  will  be  found  requiring  R,hus,  Apis,  Corydalis 
and  Alnus,  and  either  of  these  may  be  associated  or  alternated 
with  Arsenic.  When  the  tongue  is  pallid  and  dirty.  Sulphite  of 
Soda  may  be  given  in  the  usual  doses,  and  continued  for  some 
weeks.  Occasionally  Sulphurous  Acid  will  be  indicated.  In 
rare  cases  Donovan's  Solution  of  Arsenic  will  prove  better  than 
Fowler's.  If  there  is  much  derangement  of  the  stomach,  we 
frequently  derive  benefit  from  an  emetic,  and  in  many  cases, 
excretion  needs  to  be  stimulated  with  small  doses  of  the  alkaline 
diuretics. 

Associated  with  these  means,  the  patient  should  have  a  daily 
bath  of  salt  and  water,  or  in  some  cases  of  a  decoction  of  Cornus 
or  Hydrastis.  The  diet  should  be  nutritious,  and  exercise  should 
be  taken  in  the  open  air. 

When  the  local  affection  is  very  persistent,  we  may  dress  the 
ulcer  with  three  parts  of  glycerine,  and  one  of  tincture  of  muri- 
ate of  iron;  or  with  the  mild  zinc  ointment,  black  salve,  or  an 
ointment  made  of  the  inner  bark  of  the  elder.  Sometimes  a  de- 
coction of  equal  parts  of  Cornus,  Alnus  and  Rumex,  answers  an 


ECTHYMA.  469 

excellent  purpose,  or  the  tinctures  of  the  same  agents  may  be 
used.  Salicylic  Acid  with  Borax  (.5j.  of  each  to  water  Oj.)  is 
a  good  dressing;  or  Thymol  grs.  ij,  to  grs.  iv.,  to  water  5j.,  may 
be  employed  with  good  results.  When  the  ulcers  are  very  per- 
sistent, they  may  be  cauterized  with  a  saturated  solution  of 
chloride  of  zinc,  or  a  paste  made  with  this  and  Hydrastis;  and 
after  the  slough  is  cast  off,  the  part  usually  heals  kindly  with 
any  simple  dressing. 

ORDER    IV.-PUSTULiB. 

This  order  is  distinguished  by  the  formation  of  small  eleva- 
tions containing  pus,  and  hence  termed  pustule  They  are  almost 
invariably  situated  on  an  inflamed  base,  which  usually  precedes 
the  eruption,  though  in  some  cases  the  inflammation  comes  on 
after  the  appearance  of  the  eruption,  and  is  more  or  less  diffused. 
The  diseases  included  under  this  order  are  both  acute  and 
chronic,  two  of  them,  variola  and  vaccinia,  heretofore  described, 
being  eminently  contagious,  and  one,  porrigo,  being  propagated 
by  contact.  The  others  seem  to  depend  upon  some  unknown 
internal  cause. 

ECTHYMA. 

Ecthyma  may  be  divided  into  the  two  forms,  acute  and 
chronic,  the  first  occurring  most  frequently  in  children  and  young 
persons,  the  second  in  the  adult,  though  sometimes  in  children. 

SYxMPTOMS. — In  the  acute  form  it  is  usually  preceded  by  lassi- 
tude and  indisposition,  and  its  appearance  is  frequently  marked 
with  slight  chills  and  febrile  action.  It  makes  its  appearance 
in  the  shape  of  red,  circumscribed,  inflamed  spots,  which  soon 
suppurate  at  their  apices.  In  some  cases  the  eruption  is  attended 
with  pain,  the  inflammation  being  quite  severe,  but  in  others  it 
is  simply  a  sense  of  stiffness.  Some  of  the  pustules  terminate  by 
resolution,  while  others  are  succeeded  by  a  thick,  adherent  scab, 
which,  in  falling  off,  leaves  a  deep-red  mark,  and  in  some  cases 
a  cicatrix.     It  usually  lasts  for  one  or  two  weeks. 

In  chronic  ecthyma  there  is  a  successive  appearance  of  the 
eruption,  sometimes  for  months,  the  general  health  being  much 
depressed.  It  ma}'  present  the  same  ciiaracter  as  that  just  de- 
scribed, or  it  may  become  confluent  in  large  suppurating  sur- 


470  DISEASES   OF   CHILDREN. 

faces.  A  variety  termed  ecthyma  cachecticum,  occurs  in  old 
persons,  and  those  who  have  broken  their  systems  down  by  in- 
temperance. "The  skin  is  inflamed  and  more  swollen  than  in 
the  common  forms  of  the  disease.  It  assumes  a  deepened  color, 
and  in  about  six  or  eight  days  the  cuticle  is  raised  over  the  pus- 
tules, is  blackish  and  infiltrated  with  blood.  It  soon  bursts  and 
forms  a  thick,  dark  scab,  raised  at  the  center ;  the  edges  are 
hard,  callous,  and  more  or  less  inflamed.  The  scabs  are  very 
adherent  and  do  not  become  detached  for  several  weeks,  some- 
times for  months.  If  they  fall  accidentally,  an  unhealthy  ulcer- 
ation ensues,  and  the  scab  is  with  difficulty  removed.  Some- 
times febrile  symptoms  precede  or  accompany  the  eruption,  but 
they  generally  disappear  with  the  disease." — (Cazenave.) 

Diagnosis. — Ecthyma  is  usually  recognized  with  ease  by  the 
hard  and  inflamed  base,  suppuration  commencing  on  the  surface, 
and  not  deep  as  in  furunculi,  acne,  and  sycosis,  which  are  most 
frequently  mistaken  for  it,  but  in  these  the  base  is  hard,  not  in- 
flamed, and  the  pustules  are  small  and  slowly  developed. 

Treatment. — In  the  acute  form  of  the  disease  we  give  the 
special  sedative.  Aconite  or  Veratrum,  using  the  warm  bath  with 
glycerine  soap.  In  some  cases  Rhus  will  be  indicated,  in  others 
Apis,  and  in  still  others  Phytolacca.  If  the  tongue  is  broad  and 
pallid,  sulphite  of  soda  will  be  found  an  admirable  remedy,  and 
will  sometimes  eifect  a  speedy  cure.  If  the  tongue  is  red,  with 
brownish  coat  down  the  center,  sulphurous  acid  will  be  given. 

In  the  chronic  form  of  the  disease,  the  patient  may  have  Fow- 
ler's Solution,  with  Phytolacca,  or  cod-liver  oil ;  or,  if  congenital 
syphilis  is  suspected,  Donovan's  Solution,  or  iodide  of  potassium 
is  indicated.  In  some  cases  the  old  combination  of  aa.  Alnus, 
Rumex,  and  Quercus,  in  infusion,  may  be  given  internally,  and 
used  as  a  local  application. 

If  the  eruption  is  very  perverse,  a  local  application  of  brown 
citrine  ointment  one  part,  Avith  cod  oil  or  simple  cerate  two  or 
three  parts,  may  be  used.  It  needs  to  be  used  with  care,  but 
it  is  very  certain  in  its  action. 

In  some  cases  a  dry  dressing  is  preferable,  and  the  part  is 
dusted  with  subnitrate  of  bismuth. 


DISEASES  QP  THE  SKIN.  -471 


PORRIGO. 


Porrigo,  or  tinea,  is  a  disease  of  the  scalp,  and  is  generally 
known  by  the  name  of  scald-head.  It  is  undoubtedly  contagi- 
ous, and  is  propagated  from  one  to  another  by  contact ;  hence 
the  necessity  for  care  in  the  use  of  articles  of  clothing,  combs, 
baushes,  towels,  etc.  Two  varieties  are  distinguished  :  P.  favosa, 
or  tinea  capitis,  and  P.  scutulata,  or  tinea  annularis. 

Porrigo  favosa  commences  with  an  eruption  of  minute,  round, 
yellow  pustules,  which  seem  to  be  imbedded  in  the  skin.  At 
first  they  are  distinct,  and  situated  on  a  hard  base,  but  as  the 
disease  progresses  they  become  confluent,  the  entire  scalp  being 
inflamed  or  indurated.  In  a  short  time  after  their  formation, 
the  yellowisli  fluid  begins  to  concrete,  and  when  they  are  distinct 
forms  a  scab  with  a  marked  depression  in  the  center,  but  when 
close  together  they  form  one  large  scab.  If  this  is  allowed  to 
remain,  it  becomes  thick,  whitish,  and  brittle;  if  removed,  slight 
erosions  are  seen  under  it,  and  it  is  not  re-formed,  except  by  the 
appearance  of  a  new  crop  of  pustules. 

"  This  affection  is  never  accompanied  with  febrile  symptoms, 
but  a  troublesome  and  annoying  itching  is  often  present  during 
its  progress,  which  is  aggravated  by  want  of  cleanliness.  A 
number  of  lice  are  often  seen  under  the  scabs,  causing  the  pa- 
tients to  scratch  themselves,  and  by  this  means  increase  the  in- 
flammation. In  these  cases  there  is  a  strong,  disagreeable  odor, 
similar  to  that  of  cat's  urine,  given  ofi"  from  the  head.  After 
the  head  is  cleansed  from  the  scabs  the  odor  becomes  sickening. 
The  excoriations  on  the  surface,  which  often  reach  to  the  hair- 
bulbs,  and  thus  produce  baldness,  are  not  covered  with  the  reg- 
ular cup-shaped  favus  pustules,  but  a  reddish  and  fetid  sanies 
oozes  out,  which  concretes  into  irregular-shaped  scabs.  Fresh 
pustules,  however,  soon  appear,  which  give  rise  to  fresh  favus 
scabs.  Small  subcutaneous  abscesses  may  sometimes  appear, 
accompanied  with  sympathetic  engorgement  of  the  lymphatic 
glands  of  the  neck.  It  has  been  remarked  that  the  growth  of 
those  persons  who  have  been  affected  with  porrigo  is  often  ar- 
rested, and  the  development  of  the  mental  as  well  as  the  physi- 
cal powers  is  slow  and  imperfect.  The  duration  of  the  disease 
is  very  variable  and  uncertain  ;  and  the  hair,  when  reproduced, 
is  rarely  the  same  as  the  original  either  in  color  or  consistence." 
(Cazenave.)     *  ' 


472  DISEASES  OF   CHILDREN. 

Porrigo  scutulata  commences  with  the  appearance  of  red  cir- 
cular patches,  upon  which  small  yellow  pustules  are  soon  devel- 
oped. Each  pustule  has  a  hair  passing  through  it,  and  has  the 
same  cupped  appearance  as  in  the  preceding  variety ;  and  they 
appear  more  frequently  upon  the  circumference  of  the  spot  than 
at  its  center.  The  scabs  increase  in  thickness  for  some  time,  and 
when  removed  a  large  furfuraceous  patch  with  an  uneven  surface 
is  left,  from  which  the  hair  frequently  falls  off.  It  spreads  by 
spontaneous  development,  or  by  inoculation  of  other  parts  by 
scratching;  marked  and  sometimes  intense  itching  attending  the 
eruption.  Like  the  preceding  affection,  its  duration  is  variable, 
but  if  allowed  to  run  its  course  it  would  probably  continue  for 
years,  resulting  in  permanent  baldness. 

Diagnosis. — The  presence  of  the  small,  rounded,  yellow  pus- 
tule, depressed  in  its  center,  is  the  diagnostic  feature  of  both 
forms.  Porrigo  scutulata  is  determined  by  the  appearance  of 
the  eruption  in  circular  patches,  though  when  these  are  numer- 
ous, they  are  so  crowded  together  as  to  cover  the  entire  surface, 
and  the  distinction  then  between  this  and  porrigo  favosa  can  not 
be  made  out. 

Treatment. — Cleanliness  is  of  great  importance  in  this  affec- 
tion, and  to  secure  it  we  would  have  the  hair  cut  close,  and  the 
head  frequently  washed  with  castile  soap  and  water.  It  may 
be  necessary  at  first  to  soften  the  incrustations  by  continuous 
emollient  applications,  or  in  some  cases  with  poultices,  using 
soap  and  water  freely  in  the  meantime.  Having  thus  exposed 
the  scalp  we  would  apply — 1^  Oxalic  Acid,  grs.  x.  to  grs.  xx.. 
Creosote  gr.  x. ,  water  5ij. ;  M.,  and  follow  it  in  half  an  hour 
with  free  inunction  of  mild  zinc  ointment.  The  ointment  of 
iodide  of  sulphur  is  a  very  efficient  remedy,  and  should  when 
used  be  gently  rubbed  over  the  parts  night  and  morning,  the 
scalp  being  kept  perfectly  clean  by  the  use  of  soap  and  water. 
A  nicer  application  and  a  more  effectual  one  will  be  found  in 
brown  citrine  ointment  one  part,  simple  cerate  two  parts.  The 
head  may  be  thoroughly  cleansed  with  a  solution  of  salicylic 
acid  and  borax  {aa.  5j.  to  water  Oj.,)  and  the  ointment  then 
carefully  applied. 

As  regards  internal  remedies,  we  will  find  it  necessary  to  give, 
the  vegetable  alteratives  heretofore  named,  associafted  with  some 


LICHEN.  473 

preparation  of  potash,  as  the  iodide,  acetate,  carbonate,  etc. 
Sulphite  of  soda  is  an  admirable  remedy  in  some  cases,  and  sul- 
phurous acid  is  occasionally  indicated.  Usually  the  bitter  tonics 
and  iron  will  be  required  to  some  extent,  and  occasionally  cod- 
liver  oil  will  prove  beneficial. 


ORDER    V.-PAPUL^. 

This  order  is  characterized  by  small,  firm,  solid  elevations  of 
the  skin,  always  attended  with  more  or  less  itching,  and  never 
contain  pus  or  serum,  though  occasionally  from  irritation  these 
surfaces  become  ulcerated  and  covered  with  incrustations.  They 
are  developed  without  any  appreciable  cause,  are  rarely  attended 
with  febrile  symptoms,  and  are  not  contagious.  They  are  most 
generally  chronic,  but  sometimes  acute.  Two  diseases  are  in 
eluded  under  this  order — lichen  and  prurigo. 

LICHEN. 

Lichen  appears  as  small,  hard  elevations,  but  slightly  red,  or 
of  the  color  of  the  skin,  and  attended  with  severe  pruritus.  We 
may  distinguish  three  forms  :    L.  simplex,  L.  agrius,  L.  urticatus. 

Litchen  simplex  comes  out  in  the  form  of  small  and  aggregated 
papulae,  being  attended  with  severe  itching,  and  sometimes  burn- 
ing. It  most  frequently  appears  on  the  face  and  arms,  and  the 
neck  and  breast,  though  it  may  extend  to  all  parts  of  the  body. 
They  remain  stationary  for  three  or  four  days ;  when  the  redness 
gradually  declines,  there  is  slight  furfuraceous  desquamation,  and 
the  disease  terminates  in  seven  or  eight  days,  unless  there  is  a 
new  eruption.  In  many  cases  it  continues  for  weeks  or  months 
by  the  appearance  of  successive  crops  of  papulae. 

Litchen  urticatus  usually  appears  suddenly  in  the  form  of  large 
and  numerous  papula?,  attended  with  a  burning,  distressing  pru- 
ritus. It  appears  most  frequently  on  the  face,  neck,  and  ex- 
tremities, and  is  irregular  and  transitory,  subsiding  and  rea[)- 
pcaring  with  great  rapidity.  "The  papula?  are  clustered,  aiul 
they  are  either  white  or  surrounded  by  a  faint-red  areola ;  sonjo- 
times  they  are  prominent,  and  considerably  inflamed,  and  at  first 
bear  considerable  resemblance  to  flea-bites."  When  scratched 
or  otherwise  irritated,  they  frequently  bleed,  and  dark  scabs 
form  on  their  surface.     Tiie  eruption   may  disappear  with  one 


474  DISEASES   OF   CHILDREN. 

crop  of  papillae,  but  it  is  occasionally  very  obstinate,  lasting  for 
months,  by  their  successive  reproduction. 

Lichen  agrius  may  appear  spontaneously,  or  it  may  succeed 
lichen  simplex.  When  it  a})pears  spontaneously,  the  papulse  aic 
very  small,  red,  accuniinated,  inflamed  and  developed  on  an 
erythematous  surface  of  limited  extent,  which  is  generally 
attended  with  heat  and  painful  tension.  Instead  of  subsiding  on 
the  fourth  or  fifth  day,  they  continue  increasing;  slight  ulcera- 
tions form  on  their  apices,  whence  issues  a  sero-purulent  fluid, 
which  concretes  and  forms  yellowish,  prominent  crusts,  soft  aud 
slightly  adherent.  These  incrustations  fall  off,  and  are  then  re- 
placed by  thin  scaly  scabs.  Sometimes  the  redness  diminishes, 
the  inflammation  disappears,  slight  desquamation  ensues,  and 
the  disease  terminates  about  the  twelfth  or  fifteenth  day.  But 
frequently  the  discharge  continues,  and  new  crusts  are  formed, 
by  which  the  disease  is  prolonged  considerably.  The  itching 
which  accompanies  it  is  often  so  intense  that  the  patient  seeks 
the  hardest  substances  to  rub  himself  with,  and  thus  invariably 
aggravates  the  pruritus.  It  may  continue  in  this  manner  for 
several  weeks,  or  it  may  pass  into  the  chronic  state,  when  the 
scaly  incrustations  disappear,  and  are  succeeded  by  slight  exfoli- 
ation, and  the  skin  is  often  considerably  hypertrophied.  This 
form  may  last  for  months. — (Cazenave.) 

A  peculiar  form  of  disease  has  prevailed  extensively  in  the 
Western  country,  for  the  last  twenty  years,  known  as  Illinois  itchy 
soldiers^  itch,  etc.,  presenting  many  of  the  characteristics  above 
named.  Its  symptoms  seem  so  variable,  that  it  is  difficult  to 
classify  it,  as  it  sometimes  resembles  eczema,  and  at  others  im- 
petigo, and  in  others,  again,  it  presents  to  some  extent  the 
characteristics  of  all  three.  It  appears  most  generally  upon  the 
wrists  and  hands  first,  and  then  extends  to  various  parts  of  the 
body,  and  is  remarkably  persistent  and  annoying. 

Diagnosis. — The  diagnosis  of  litchen  is  very  difficult,  as  it 
may  be  mistaken  for  eczema,  porrigo,  scabies,  or  impetigo,  but 
it  may  usually  be  determined  by  the  presence  of  some  of  the 
characteristic  papulae. 

Treatment. — Lichen  agrins  is  more  difficult  to  manage,  and 
no  remedy  seems  to  answer  in  all  cases.  In  some,  I  have  had 
very  good  success  with  glycerine  and  tincture  of  muriate  of  iron 


PRUSIGO.  475 

in  the  proportion  three  parts  of  the  first  to  one  of  the  last,  giveti 
internally  in  teaspoonful  doses  four  times  a  day.  A  lotion  of 
muriate  of  ammonia  has  been  frequently  employed,  composed 
of — II  Hydrochlorate  of  Ammonia  5j.,  vinegar  Siv.,  water  Oj., 
and  applied  freely  to  the  affected  parts.  In  some  cases  the  in- 
ternal administration  of  the  compound  tincture  of  Corydalis,  with 
iodide  of  potassium,  and  a  wash  of  a  decoction  of  equal  parts  of 
Cornus,  Alnus,  and  Rumex,  has  answered  a  good  purpose.  In 
other  cases  a  lotion  of — II  Glycerine  sij. ;  Oxide  of  ZinC,  5ss., 
Morphia  grs.  v.)  Kose-water  5iv.,  has  answered  an  excellent 
purpose,  as  has  the  ointment  of  elder  and  the  mild  zinc  oint- 
ment. In  other  cases,  good  results  will  be  obtained  by  the 
internal  use  of  sulphur,  and  its  local  employment  as  a  bath, 
wash,  or  ointment. 

PEURIGO. 

Several  varieties  of  this  disease  are  described,  but  many  of 
them  are  named,  not  from  any  jn'ominent  difference  of  symptoms 
but  more  on  account  of  their  location.  The  disease  is  character- 
ized by  the  appearance  of  papulae,  usually  larger  than  those  of 
lichen,  and  without  discoloration  of  the  skin,  which  are  attended 
by  very  severe  pruritus,  and  sometimes  burning.  Three  varie- 
ties may  be  named,  P.  mitis,  P.  formicans,  P.  senilis. 

Prurigo  mitis  is  the  mildest  form  of  the  disease,  and  is  usually 
acute.  The  papulse  are  slightly  prominent,  but  very  small,  and 
accompanied  with  intense  itching.  In  prurigo  formicans  the 
papulse  are  much  larger,  and  flattened,  and  distinct,  and  accom- 
panied with  an  intolerable  pruritus,  which  increases  at  night, 
and  by  the  warmth  of  the  bed.  If  not  irritated  by  scratching, 
they  frequently  disappear  in  the  course  of  one  or  two  weeks,  but 
frequently  the  skin  is  torn  in  the  efforts  for  relief,  and  the  part 
bleeds,  and  a  dark  thin  scab  is  formed  on  its  surface.  It  may 
continue  for  a  considerable  time  by  continued  development  of 
the  eruption.  In  old  })eople,  or  in  weakly  children,  the  papuhtt 
are  frequently  large  and  prominent,  and  the  skin  becomes 
thickened  and  inflamed ;  vesicles,  pustules,  and  boils  form,  ami 
being  opened  by  scratching  give  rise  to  unpleasant  excoriations 
and  superficial  ulcers,  and  a  most  intense  burning  and  itching. 
It  may  thus  last  for  months,  or  even  years.  Prurigo  may 
attack  any  part  of  the  body,  but  is  most  severe  when  it  attacks 
the  gcnitial  or<:;ans,  or  is  situated  around  the  anus. 


476  DISEASES  OF  CHILDREN. 

Diagnosis. — Prurigo  may  be  distinguished  from  lichen  by  its 
larger  papulae,  and  the  dark  incrustations  which  are  sometimes 
fjrmed  on  them ;  from  scabies  by  the  accumiuated  vesicles  of  the 
latter,  and  their  rose-colored  base.  It  may  be  associated  with 
lichen,  scabies,  eczema,  impetigo  and  ecthyma,  and  in  such  cases 
the  diagnosis  will  of  course  be  difficult. 

Treatment. — In  the  milder  forms  of  the  disease,  the  re- 
moval of  any  internal  irritation,  and  soothing  local  applications, 
are  all  that  is  required.  Frequently  it  is  desirable  to  keep  the 
bowels  open  with  a  saline  purgative,  and  give  an  alkaline  diure- 
tic, with  some  gentle  diaphoretic.  As  a  local  application,  the 
glycerine  lotion  will  answer  a  very  good  purpose ;  or  we  may 
use  it  with  chloroform,  adding  ten  or  fifteen  drops  of  it  to  each 
ounce  of  the  lotion.  A  solution  of  borax  answers  a  very  good 
purpose,  as — I^  Borax  5ij-,  Morphia  gr.  v..  Rose-water  ovj. 
A  decoction  of  Hydrastis  or  Cornus,  with  borax  and  morphia,  is 
frequently  beneficial. 

N^VUS    MATERNI. 

It  is  generally  supposed,  and  I  think  with  truth,  that  certain 
impressions  made  upon  the  mother's  mind  during  pregnancy  will 
affect  the  growth  and  structure  of  the  child,  and  in  some  manner 
deform  it.  It  is  true  that  we  can  not  account  in  a  rational  man- 
ner for  any  such  occurrence,  but  the  instances  are  so  numerous 
that  we  can  not  dispute  the  connection  between  the  impression 
and  the  mark. 

Very  frequently  we  find  women  making  anxious  inquiry  with 
regard  to  the  matter,  as  they  are  strongly  impressed  that  thei/ 
have  received  some  shock  or  sudden  impression  which  will  mark 
or  deform  the  child.  As  it  is  so  rarely  that  nJBvi  result  from 
these  impressions,  we  arc  safe  in  giving  such  assurance  to  the 
prospective  mother  as  Avill  quiet  her  fears. 

Numerous  instances  are  related  to  prove  the  relation  between 
the  impression  on  the  mother's  mind  and  the  deformity  of  the 
child.  The  severest  case  of  the  kind  that  ever  came  under  my 
observation  was  a  child  born  with  a  hand  so  completely  deformed 
as  to  be  useless,  and  which  was  attributed  to  the  mother's  wit- 
nessing the  dressing  of  a  hand  that  had  been  crushed  in  a  tlircsh- 
inir  machine.     In  another  case  the  child   had  a  vascular  no3vus 


NiEVUS  MATERNI.  477 

Oil  the  cheek,  immediately  below  the  eye.  The  mother  attributed 
the  mark  to  her  husband's  throwing  aeherry  at  her,  which,  strik- 
ing upon  the  same  part  of  the  cheek,  burst,  and  not  only  star- 
tled her  at  the  time,  but  firmly  impressed  her  mind  that  the  child 
would  be  marked. 

The  deformities  and  distortions,  that  are  rarely  met  with,  may 
frequently  be  remedied  by  the  surgeon,  as  in  talipes,  hair-lij), 
cleft-palate,  etc.,  but  we  will  not  attempt  to  describe  them  here. 

The  most  common  form  of  mother's  mark  is  a  discoloration 
of  the  skin,  from  an  increase  in  the  size  of  the  blood-vessels.  It 
may  be  located  upon  any  part,  and  usually  increases  in  size  as 
the  child  grows.  In  some  cases  it  is  so  large  at  birth  that  it  is 
useless  to  interfere,  as  where  it  involves  one-fourth,  or  sometimes 
one-half  of  the  face.  In  other  cases  it  is  but  the  size  of  a  five 
or  ten  cent  piece,  and  frequently  not  larger  than  a  grain  of  wheat. 

There  is  much  difference  in  the  rapidity  of  growth.  In  some 
it  is  very  slow,  so  that  the  spot  will  not  have  doubled  in  size  to 
adult  years;  in  others  it  grows  rapidly,  and  will  have  doubled 
its  size  the  first  month.  In  the  first  operative  interference  is  not 
so  necessary,  and  may  be  postponed ;  in  the  second  the  noevus 
should  be  removed  as  early  as  possible. 

The  vascularity  varies  in  different  cases.  In  some  it  is  a  true 
anastomotic  aneurism,  occasionally  distinctly  pulsating.  In  these 
much  care  should  be  used  to  prevent  hemorrhage  in  any  opera- 
tion that  may  be  undertaken. 

In  others  the  disease  is  wholly  confined  to  the  capillaries,  and 
the  operation  outside  of  the  spot  will  not  cause  greater  hemor- 
rhage than  for  any  other  purpose. 

The  bright  vivid  coloration  is  met  with  in  those  cases  where 
the  arterial  capillaries  are  involved ;  the  purplish  discoloration 
where  the  veins  are  dilated. 

We  rarely  meet  with  a  case  upon  the  skin  where  the  growth 
is  such  as  to  form  a  red  tumor,  projecting  from  the  skin.  But 
when  it  is  at  the  junction  of  the  skin  and  mucous  membrane,  as 
on  the  lip,  or  wholly  of  the  mucous  membrane,  as  sometimes  of 
the  tongue  or  mouth,  and  occasionally  about  the  reproductive 
organs,  we  frequently  find  it  assuming  the  form  of  an  erectile 
tumor.  Occasionally  the  structure  gives  way  in  such  cases,  and 
there  is  profuse  hemorrhage. 


478  DISEASES  OF   CHILDREN. 

Treatment. — A  great  many  plans  of  treatment  have  been 
recommended  for  nsevus.  The  most  commonly  adopted  are  by 
excision,  strangulation  by  ligature,  and  removal  with  escharotlcs. 

Where  the  growth  is  not  markedly  vascular,  the  smaller  capil- 
laries being  alone  involved,  the  best  plan  is  to  excise  the  growth. 
Where  the  tissues  are  loose,  or  when  the  growth  is  oblong  or  oval 
in  form,  the  edges  may  be  drawn  together  with  silver  sutures, 
and  uniou  obtained  without  any  scar. 

If  the  surgeon  fears  hemorrhage,  he  inserts  his  ligatures  before 
operating.  The  needle  is  carried  through  the  sound  skin,  and 
beneath  the  n£evus,  drawing  the  wire  through  and  clipping  it  at 
proper  length.  Enough  are  inserted  in  this  way  to  insure  an 
arrest  of  bleeding. 

Strangulation  by  ligature  is  performed  by  transfixing  the  base 
of  the  growth  one  or  more  times,  and  tying  it  in  separate  parts 
so  tightly  as  to  cut  oif  the  circulation. 

Probably  nitric  acid  is  the  best  caustic  for  the  removal  of  nsevi. 
Sir  B.  Brodie  remarked  :  "  Caustics  may  be  used  with  advantage 
in  congenital  tumors,  nsevi,  etc.  Little  vascular  spots  on  child- 
ren's faces  are  an  object  of  anxiety.  If  you  look  at  these,  you 
will  see  one  large  vessel  and  several  branches  supplying  them. 
You  may  destroy  them  in  the  following  manner:  Take  a  glass 
pen  [a  pine  stick  pointed  answers  the  same  purpose]  which  will 
hold  nitric  acid,  and  apply  it  to  the  principal  vessel,  puncture  it, 
and  insert  into  the  puncture  a  fine  point  of  potassa  fusa  ;  a  mo- 
ment's touch  will  be  sufficient  to  destroy  the  vessel;  if  the  po- 
tassa extends  further  than  you  intended,  apply  vinegar.  You 
may  thus  obliterate  the  vessel  without  leaving  a  scar.  There 
are  some  congenital  nsevi  abounding  in  the  skin,  formed  by  an 
intricate  mesh  of  vessels;  the  skin  is  elevated  and  of  a  mulberry 
color.  If  these  are  of  a  large  size,  they  must  be  destroyed  by 
ligature  or  the  knife;  if  of  smaller  size  you  may  use  caustics  not 
unprofitably.  The  nitric  acid  is  the  best  application;  this 
makes  a  slough,  the  blood  coagulates  and  the  parts  become  in- 
durated. This  is  only  applied  when  ntevi  are  of  small  size.  In 
subcutaneous  nsevi,  which  are  not  of  the  same  color  but  purple, 
caustics  may  be  applied  to  effect  their  destruction,  whether  of  a 
large  or  small  size  ;  tlie  great  object  is  to  destroy  them  with 
caustics  rather  than  the  ligature.  These  nrevi  have  been  cured 
by  application  of  vaccine  matter,    which  acts  by  producing  a 


NJEVUS   MATERNI.  479 

slough.  You  may  cure  these  subcutaneous  nsBvi  upon  the  same 
principle;  puncture  them  with  a  finely-pointed  lancet,  then 
having  a  probe  armed  with  nitrate  of  silver,  introduce  it  into 
the  puncture — the  caustic  presently  causes  sloughing,  and  the 
vessels  are  obliterated." 

Lately  the  removal  of  nffivi  by  the  use  of  hypodermic  injec- 
tions into  the  growth,  has  been  strongly  recommended.  The 
solution  of  per-sulphate  of  iron  has  been  employed  in  this  way, 
and  it  is  claimed  with  great  success.  One  fatal  case,  however, 
has  been  reported,  in  which  the  death  was  evidently  due  to  the 
injection. 

When  the  nfevus  is  quite  superficial,  its  removal  may  be  at- 
tempted by  the  use  of  a  strong  tincture  of  iodine.  A  very  good 
formula  is — I^  Tincture  of  Iodine  (to  saturation),  Aqua  Ammo- 
nia, aa.  Sj. ;  let  it  stand  in  a  well-corked  bottle  for  a  week,  and 
it  is  ready  for  use.  Apply  this  daily  with  a  camel's-hair  brush, 
and  the  nsevus  will  gradually  yield. 


IlSriDEX. 


Action  of  ramedies 21 

Acids 57,  104,  96 

Acid,  hydrochloric ~57,  96 

sulphurous 97, 101 

nitric 108 

Acetate  of  potash 84 

Acetous  tincture  of  Lobelia 71 

Aconite 42,  56,  62 

^^ther 36 

Agrimonia 86 

Ague 144 

Air 55,   112 

Alkaline  salts 58 

Aloes 84 

Alteratives 52 

Albuminuria 363 

Albugo  435 

Alstonia 107 

Ammonium  carb 39 

bromide  of. 31 

Amygdalis 73 

Antierysipclatous  109 

Antiperiodicf 105 

Antirheumatics 102 

Antiseptics IOC 

Antispasmodics 26 

Antizymotics 95 

Analysis  of  disease 21 

Anus,  prolapse  of. 338 

Appendages  of  the  eyes 427 

Apis „ 94,  111 

Apocynum.„ 79,  103 

Aphtha; 294 

Arsenic .95,  108 

Ascaris 342 

Asafcetida 40 

Asclepias 92 

Asthenic  bronchitis 270 


(481) 


Baths ^ 51^  88 

alkaline  sponge 52,  89 

acid  sponge 52,  89 

cold  pack 51,  89 

hot  pack 51,  90 

hot  foot  ~ 90 

hot  sponge 90 

hot 91 

inunction 91 

stimulant 53 

tonic....... ^   53 

Baptisia 57,  98 

Belladonna 28,  85,  94 

Benzoate  of  lithia 87 

Bites  and  stings 240 

Bryonia 30,  57,  63,  103 

Bromide  of  ammonium 31 

Bronchial  catarrh 270 

Bronchitis,  asthenic 270 

acute.... 274 

chronic 278 

Breast  pump.. 124 

Brain,  dropsy  of 395 

inflammation  of 385 

determination  to 383 

congestion  of. 384 


Camphor 36 

Care  after  birth 119 

Catarrh,  bronchial 270 

Care  of  the  teeth 255 

Cancrum  oris 298 

Caruncula  lachrymalis 430 

Carbolic  acid 101 

Calculi 372 

Cathartics... 72 

Cerobro-spinal  meningitis -173 


482 


INDEX. 


Chloroform 36 

Chamomilla 75,  115 

Chronic  catarrh „ 246 

bronchitis 278 

hydrocephalus— 395 

pharyngitis 205 

nephritis 361 

Chloral  hydrate 38 

Chlorate  of  potash 98,  IIC 

Chloride  of  lead 102 

lime 101 

Cljolera  infantum 322 

Chlorinated  soda 101 

Chorea 415 

Chionanthus 76 

Chelidonium 77 

Chafing „ 123 

Circulation,  derangements  of 41 

remedies  influencing 41 

Cinchonidia 107 

Classification  of  remedies 25 

of  disease.. 140 

of  fevers 142 

Clothing  the  child 120 

Compound  powder  of  rhubarb 74 

Cod-liver  oil 60 

Constituents  of  milk. 126 

Congestive  fever 123 

Continued;fever... 127 

Coryza 245 

Colic 317 

Constipation 33G 

Congestion  of  the  liver 346 

of  the  brain 384 

Convulsions ...410 

Conjunctivitis 432 

Cornea,  opacity  of 435 

Cold  pack 51 

Colocynth 75 

Consumption 285 

Cow-pox 201 

Cough 243 

Croup,  mucous 257 

pseudo-membranous 261 

spasmodic 266 

Cuprum 117 

Curvature  of  spine 400 

D 

Digestive  apparatus 20 

diseases  of. 289 

remedies  for 69 


Dentition 292 

derangements  of. 289 

Determination  to  the  brain  .....383 

Deafness 444 

Direct  medication 21 

Diaphoretics 87 

Diuretics 82 

Digitalis 46 

Diphtheria 183 

Difficulties  in  nursing  the  child 124 

Dioscorea 78 

Discovery  of  vaccination 202 

Diarrhcea 319 

Diabetes 365 

Diseases  of  the  liver 346 

nervous  system 382 

eyes 424 

appendages  of  the  eyes 427 

ears « 436 

skin „...448 

Dysentery 333 

Dyscrasias 232 

-El 

Ear,  foreign  bodies  in 438 

inflammation  of 439 

Earache 438 

Ear,  examination  of. 437 

Eczema 458 

Ecthyma 469 

Emetics 70 

Epilepsy 405 

Enuresis 370 

Enteritis 320 

Eryngium 85 

Ergot , 35 

Erythema 450 

Erysipelas 455 

Eruptive  fevers 190 

Eupatorium 45,  64,  85,  93 

Euphorbia 66,  75 

Excretory  apparatus 

Exercise 55,  112 

Exanthemata 449 

Febrile  diseases 140 

Fever,   pathology  of 141 

classification  of. 142 

intermittent 144 

masked 149 

remittent 149 


INDEX. 


483 


Fever,  slow  infantile 156 

congestive 160 

continued 164 

typhoid 167 

spotted 172 

eruptive 190 

Febricula 142 

Ferro-cyanide  of  potassium 40 

Fistula  lachrynialis 429 

Form  of  remedies 22 

Food 54 

rules  for  giving 114 

Liebig's 125 

for  the  child 124 

Foreign  bodies  in  the  ear 438 

Furuncle 427 

G 

Gastrodynia 307 

Gastric  irritation 308 

Gastritis 310 

Gastric  intermittent 146 

Gangrenous  stomatitis 298 

Gelseminum 27,  44,  85 

Grindelia 68 

Government,  moral 132 

Gums,  lancing 290 

Hamamelis 48,  175 

Hernia 356 

Herpes 461 

Hives 453 

Hot  pack 51 

Hot  foot-bath 90 

Hot  bath 91 

How  to  wean  the  child 128 

Hydrastis .■ 78 

Hydrochloric  acid 96 

Hypophospbites 69 

Hydrangea 86 

Hydrocele 378 

Hydrocephalus,  acute 391 


Icterus  neonatorum 352 

Imperforate  urethra 375 

Intermittent  fever 144 

nervous 145 

gastric 146 

inflammatory 146 

raasited 14.9 


Inoculation 201 

Infantile  syphilus 234 

dyspepsia 312 

Intestinal  worms 340 

Infantile  leucorrhcea 379 

Inflammation  of  the  lungs 280' 

Infantile  therapeutics 17 

Irritation,  avoidance  of. 18 

Ipecacuanha 63,  71,  74 

Iron.. 110,  116 

Iris.- 80 

Iron,  sulphate  of 101 

Ischuria 367 

Itch 463 

Illinois ~474 


Jaundice 350 

Jenner   Dr 202 

Kidneys  inflammation  of 358 


Lachrymal  apparatus 428 

sac,  inflammaticJh- 428 

puncta 428 

Lancing  the  gums 290 

Lesions  of  bloodmaking 

Leptandra   80 

Leucoma 435 

Leucorrhcea  infantile ,379 

Lichen 473 

Light 112 

Life  line 137 

Lime 118 

Liebig's  food 125 

Liver,  diseases  of 346 

congestion  of 346 

strumous  diseases  of 348 

Lithotrity 375 

Lithotomy 375 

Local  applications  to  loins 368 

Lobelia 32,  46,  63,  71,  74 

Lumbricoid  worms 342 

Lycopus 46,  65 

Lymph  vaccine 254 

m: 

Macrotys ^ 103 

Manganese  sulph 80 

Malignant  measles 209 

scarlet  fever 214 


484 


INDEX. 


Malignant  sore  throat 302 

Malt 80 

Medication  direct 21 

Medicines,  classification  of 25 

Mental  impressions 133 

Mentha  viridis 83 

Medicines  ■which  influence  the  ner- 
vous system 18 

Medicines  afterbirth , 123 

Medicine,  dose  of. 24 

Measles 204 

sequelae 210 

Meningitis 397 

Milk.... ^ 126 

Milaria 458 

Milkscall 458 

Moral  government 132 

Muco-enteritis  320 

Mumps 223 

3S" 

Narcotics 38 

Xsevus  materni 476 

Nepeta  cataria.'. 93 

Nervous  system 382 

Nephritis,  acute 358 

Nettle-rash 453 

chronic 361 

Nervous  system,  disease  of 382 

Nebula 435 

Nitric  acid 62 

Nipple  shields 124 

Nitre,  spirits  of 47 

Night  terrors  421 

Nurse,  wet - 127 

Nux  vomica 33,  Gl,  76 

Nursing,  difficulties  in 126 

bottles 126 

Nursery  lamp 126 

O 

Objections  to  weaning 129 

Obstruction  of  the  puncta 428 

Oedema  glottidis 268 

(Enothera 40 

Oil,  cod-liver Go 

One  thing  at  a  time 22 

Onanism 380 

Opium 38 

Ophthalmia  neonatorum 425 

Ophthalmia  tarsi ~ 430 


Opacity  of  the  cornea 435 

Otitis  439 

Otorrhea 442 

Oxide  of  zinc, 81 

Paraphymosis 377 

Paralysis 422 

Papulae 473 

Pathology 134 

Parotitis 223 

Permanganate  of  potash 102 

Percussion 244 

Peritonitis 354 

Pemphigus 466 

Pepsin .\ 81 

Pertussis 221 

Phosphate  of  soda 72 

Phosphorus 39,   59,  67,  116 

Phytolocca 64,  99,  104 

Phisiological  marriage 135 

Physical  diagnosis _ 242 

Phthisis 285 

Phymosis .' 377 

Phrenitis 385 

Pharyngitis 250 

Pleasant  remedies 24 

Pneumonia '. 280 

Podophyllin 48,  77 

Potash,  acetate  of 84 

permanganate  of 102 

chlorate  of 98 

Porrigo 471 

Poisonous  bites 240 

Preservation  of  lymph „.207 

Prurigo 475 

Prolapsus  ani 338 

Pseudo-membranous  croup 261 

Ptosis 427 

Pulsatilla 32 

Pulse 139 

Q 

Quinia 34,  60,  106,  115 

Quinsy 253 

R 

Kemedies,  form  of 22 

pleasant 23 

Restoratives - Ill 

Rest 13 

Respiration 137,  14D 


INDEX, 


485 


Eespiratory  npparatu?,  renaedies  for  G2 

Best  necessary 18 

Reasons  for  weaning ; 128 

Regular  habits 131 

Remittent  fever 149 

with  diseases  of  the  brain... 151 

with  diseases  of  the  lungs 152 

slow 15G 

Respiratory  apparatus,  diseases  of... 242 

Retention  of  the  urine 3GT 

Rumex ~ C8 

Rhubarb T3 

Rhus  Tox 29,  45,  57,  94,  111 

Rhus  Aroma 86 

Rheum- 73 

Roseola 451 

infantilis 451 

ajstiva 451 

annulata 452 

Rubeola » 207 

maligna • 209 

sequelae  of 210 

Rupia 467 

simplex 467 

prorainens 467 

escharotica 463 


Santonine 81,  84 

Salicylic  acid 61,  103 

Salicin 62 

Sanginaria 65 

nitrate  of 66 

Sciilas 67 

Scarlatina 212 

simplex 213 

anginosa „.213 

maligna 214 

sequelae 216 

scald  head 471 

Scrofula ....225 

Scabies 463 

Sedatives 83 

action  of 83 

Senega 94 

Second  dentition „ 294 

Serpentaria 93 

Silica 117 

Skin,  remedies  for ST 

disonses  ©f 443 

Sleeping.  ^ „,.. 130 


Slow  infantile  remittent 156 

Small-pox ...192 

Soda 118 

Sore  throat 300 

malignant 3C2 

chronic 305 

Spotted  fever 172 

Spurious  vaccination 205 

Sputa 244 

Spasmodic  croup 266 

Spinal  meningitis 397 

St.  Yitus'  Dance 415^ 

Spine,  curvature  of 4C0 

Sticta ; G7,  104 

Stimulants 488 

Stillingia 65 

Stings .240 

Stomatitis  simplex 293 

ulcerata 297 

gangrenous 298 

Strumous  liver 343 

Sulphur 94,  116 

Sulphite  of  soda 98,  111 

Sweet  spirits  of  nitre 47 

Syphilis  from  vaccination 200 

Syphilis,  infantile 234 

T 

Tabes  mesenterica 330 

Tffinia ~  342 

Test  for  milk 125 

Tetter :..459 

Temperature 137 

Teeth,  care  of 291 

Tinctures  preferred 23 

Tincture  of  iron 1 10 

Thymol -100 

Tonics 115 

Tonsillitis 253 

Trismus  nascentium 420 

Trichiasis 428 

Typhoid  fever 167 

XJ 

Ulceration  of  the  umbilicus -122 

ITlcerated  sore  mouth 297 

Umbilical  hernia 257 

Urethritis 377 

Urine,  suppression  of 367 

retention  of 368 

Urinary  calculi 377 

Urethra,,  ijnperforute 375 


486 


INDEX, 


Urinary  apparatus,  diseases  of..— «,358 

remedies  for 82 

Urticaria ..453 

Urine,  incontinence  of 370 

Uvedalia 109 

V 

Variola 192 

Varioloid 200 

Vaccine  disease 201 

Vaccination 203 

Vaccine,  discovery  of. 202 

vesicle 204 

Vaccination,  spurious 204,  205 

syphilis  from 206 

Vesiculse 458 

Veratrum 43,  56,  63,  111 

Viability 137 


W 

Warm  water 92 

"Warm  drinks  92 

Washing  the  child 119 

how  often 121 

Wet-sheet  pack 51 

Weaning  the  child 128 

reasons  for 128 

objectione  to 129 

bow  to 129 

Wet-nurse 127 

Whooping  cough 221 

Worms,  intestinal 340 

long  round 342 

thread 342 

tape 342 

Z 

Zinc  oxide 81 

Zymosis 95 


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Return  this  material  to  the  library 

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RWO«^LLIBBABVFACtLir| 


p,    000  431  505  7 


WSIOO 
Sk36e 
1881 
Scudder,  John  M. 

Eclectic  practice  in  diseeises  of 

children 


MEDICAL  SCIENCES  LIBRARY 

UNIVERSITY  OF  CALIFORNIA.  IRVINE 

IRVINE,  CALIFORNIA  92664 


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